Public Health Liver Group

We set and advance the global public health and policy agendas for equitable liver health, partnering with a multidisciplinary community that includes scientific, medical, patient advocacy, industry and governmental representatives.  

With a focus on metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as NAFLD) and metabolic dysfunction-associated steatohepatitis (MASH, formerly known as NASH) and viral hepatitis, our group pursues research in the following areas:

• Public health liver policy
• Liver health epidemiology 
• Models of care including trials, development and community implementation of scalable approaches to liver health
• Economic analyses  
• Person-centred care 
• Health systems

Our aspiration is to end the MASLD/MASH and viral hepatitis public health threats by 2030.

To do that, we strive to inform and implement solutions for the public health policy, epidemiology and operations challenges presented by major liver health risks. In addition to real-world implementation studies, epidemiological studies and reviews, we also sit and advise on three World Health Organization, European Association for the Study of the Liver, and Global NASH Council guideline committees.

The ISGlobal Public Health Liver Group has played an active role in liver health for steatotic liver disease (SLD), including metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH).

We have contributed to the field through various high-impact initiatives such as:

• Leading the NAFLD public health consensus statement in 2021
• Spearheading the development of new nomenclature for fatty liver disease, published in three major society journals (Nature Reviews Gastroenterology & Hepatology, Hepatology [AASLD] and Communications Medicine) in June 2023
• Leading the establishment of the global research and action priorities, published in the Journal of Hepatology (EASL) and Hepatology (AASLD), respectively
• Organising the annual Global Think-tank on Steatotic Liver Disease in Barcelona, Spain, where industry experts, practitioners and patient advocates gather to create policy-oriented recommendations and necessary operation actions to advance public health responses to SLD 

In 2021, together with the EASL International Liver Foundation, we led the 14 Economist Intelligence Unit workshops around the world, culminating in the report “NAFLD: Sounding the alarm on a global public health challenge” and three Wilton Park think-tank meetings.

On 23 Sep 2024, with organisational support from the Economist Impact, we are holding the first-ever United Nations General Assembly side-event on MASLD/MASH. This event comes on the heels of the recently inaugurated city-based initiative we lead in the United States - MASH Cities, which aims to bring together local politicians, community leaders, and clinicians to elevate the profile of liver disease.

EU Projects

1. Liveraim

The ISGlobal Public Health Liver Group is committed to the elimination of viral hepatitis as a public health threat, as set out in the WHO Global Health Sector Strategy on Viral Hepatitis.

To achieve this aim, we perform ground-breaking research encompassing real-world interventions that seek to reduce morbidity and mortality including liver cancer prevalence in Europe and sub-Saharan Africa. We have also launched the micro-elimination approach to hepatitis C elimination and played pivotal roles in creating World Hepatitis Day and awareness campaigns like Finding the Missing Millions. Our work has also been complemented by our active involvement in both The Lancet Gastroenterology and Hepatology Commission on viral hepatitis and the EASL-Lancet Liver Commission: Protecting the next generation of Europeans against liver disease complications and premature mortality.

In our field research, we include person-centred linkage-to-care processes to help direct linking of positive cases to healthcare systems. We use novel and simplified diagnostic tools to facilitate testing processes and adapt them to community-based settings.

Current projects include:

• VH-COMSAVAC, a project based on the implementation of community-based interventions aiming to scale-up HBV and HCV testing and HBV vaccination among migrant and refugee populations in Europe (Barcelona, Madrid, Milan and Athens). In 2024, we expanded the project to Portugal and included HDV.

Past projects include:

• Hep C Free Baleares was aimed at eliminating HCV in the Balearic Islands using a micro-elimination approach and targeting people who used drugs. In June 2024, we published an article in EASL’s JHEP Reports shedding light on the development & implementation of this care model. This micro-elimination effort offered HCV care to 1,423 people who used drugs. The decentralised screening, diagnosis, & treatment model also resulted in a sustained virologic response in 93% of those who both completed therapy & were monitored post-treatment completion.

• AFROPLAS took place in Uganda and Cameroon and aimed to evaluate the acceptability and feasibility of utilising the plasma separation card for blood sample collection to screen for HBV and HCV among people living with HIV. Final study results were published in March 2024. In June 2024, we wrote a blog post for Springer Nature’s “Behind The Paper” that explored the motivations and trademark features of this study, and what it could mean for those undiagnosed with either HBV or HCV.

Blog posts

• Bridging the Knowledge Gap in Viral Hepatitis

For our latest studies on viral hepatitis, see:

• Lazarus JV, Picchio CA, Byrne CJ, et al. A Global Systematic Review of Hepatitis C Elimination Efforts through Micro-Elimination. Semin Liver Dis 2022;42(2):159-172.
• Picchio CA, Nomah DK, Araujo SG, et al. A novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain. Sci Rep 2021;11(1):17063.
• Picchio CA, Lens S, Hernandez-Guerra M, et al. Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review. Sci Rep 2021;11(1):24133.
• Lazarus JV, Picchio CA, Guy D, et al. Hepatitis C standards of care: A review of good practices since the advent of direct-acting antiviral therapy. Clin Res Hepatol Gastroenterol 2021;45(2):101564.
• Lazarus JV, Picchio C, Dillon JF, et al. Too many people with viral hepatitis are diagnosed late - with dire consequences. Nat Rev Gastroenterol Hepatol 2019;16(8):451-452.
• Lazarus JV, Al-Rifai A, Sanai FM, et al. Hepatitis delta virus infection prevalence, diagnosis and treatment in the Middle East: A scoping review. Liver Int 2022.

Previously, our research group made transformative strides in HIV/AIDS and COVID-19 research, substantially advancing prevention, treatment, and care. Our impact can be seen not only in the many high-profile publications, including two Lancet commissions, but more importantly, in the real-world changes in guidelines and policies for these diseases.

For example, we led the authorship of the global consensus statement on HIV and health systems after proposing the groundbreaking "fourth 90" in monitoring quality of life for HIV. We also were a major author of the Nature Reviews Disease Primer on HIV and led The Lancet HIV series on HIV Beyond Viral Suppression, which was launched in the European Parliament.

During the COVID-19 pandemic, our team spearheaded a study on ending COVID-19 as a public health threat published in Nature. This monumental effort brought together 386 experts from 112 countries and territories to produce 41 consensus statements and 57 actionable recommendations across key areas like communication, health systems, vaccination, prevention, treatment and care, and inequities. Compounding these actions were other insightful studies on COVID-19 vaccine hesitancy in Nature Medicine and Nature Communications and our active involvement in The Lancet COVID-19 Commission.

For some of our studies on COVID-19 and HIV/AIDS, see:

COVID-19:

• Lazarus JV, Ratzan SC, Palayew A, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nature Med 2020;27(2):225–8.
• Lazarus JV, Wyka K, White TM, et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nature Med 2023;1–10.
• Lazarus JV, Wyka K, White TM, et al. Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021. Nature Commun 2022;13(1):1–14.
• Lazarus JV, Romero D, Kopka CJ, et al. A multinational Delphi consensus to end the COVID-19 public health threat. Nature 2022;611(7935):332–45.
• El-Mohandes A, White TM, Wyka K, et al. COVID-19 vaccine acceptance among adults in four major US metropolitan areas and nationwide. Sci Reports 2021;11(1):1–12.
• Lazarus JV, Bassat Q, Crespo J, et al. Vaccinate fast but leave no one behind: a call to action for COVID-19 vaccination in Spain. Communications Medicine 2021;1(1):1–4.
• Lazarus JV, Picchio CA, Nayagam S, et al. Strengthening vaccine confidence during the COVID-19 pandemic: A new opportunity for global hepatitis B virus elimination [Invited editorial]. J of Hepatol 2020;73:490-492.
• Picchio, C.A., Valencia, J., Doran, J. et al. The impact of the COVID-19 pandemic on harm reduction services in Spain. Harm Reduct J 17, 87 (2020). https://doi.org/10.1186/s12954-020-00432-w.
• Trenton M White, Lucinda Cash-Gibson, Jose M Martin-Moreno, Rafael Matesanz, Javier Crespo, Jose L Alfonso-Sanchez, Sonia Villapol, Ayman El-Mohandes, Jeffrey V Lazarus, COVID-SCORE Spain: public perceptions of key government COVID-19 control measures, European Journal of Public Health, Volume 31, Issue 5, October 2021, Pages 1095–1102, https://doi.org/10.1093/eurpub/ckab066.

HIV/AIDS:

• Lazarus JV, Safreed-Harmon K, Kamarulzaman A, et al. Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV. Nat Commun 2021;12(1):1–14.
• Safreed-Harmon K, Anderson J, Azzopardi-Muscat N, et al. Reorienting health systems to care for people with HIV beyond viral suppression. Lancet HIV 2019;6(12):e869–77.
• Lazarus JV, Safreed-Harmon K, Barton SE, et al. Beyond viral suppression of HIV - the new quality of life frontier. BMC Med 2016;14(1):94.
• Fuster-Ruiz de Apodaca MJ, Safreed-Harmon K, Pastor de la Cal M, et al. Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain. Front Psychol 2021;0:1977.

EU Projects

• INTE-AFRICA 
• META Trial