How can we effectively measure global progress in the control of hepatitis C? A group of experts, led by ISGlobal researcher Jeffrey V. Lazarus, has defined a consensus “cascade of care” for hepatitis C, with clearly defined stages. This standardised approach, published in Clinical Infectious Diseases, will help identify gaps and measure national and global progress towards the WHO 2030 targets.
Step up efforts
The World Health Organization calls for the elimination of viral hepatitis as a major public health threat by 2030. Specifically, the targets for hepatitis C (HCV) include an 80% reduction in new cases, diagnosing 90% of infected people, treating 80% of diagnosed people and reducing deaths by 65%. Meeting these targets will require many countries to make greater efforts – out of 71 million people estimated to be infected with HVC in 2015, only 20% were diagnosed and only 7% of those diagnosed began treatment that year.
WHO established a monitoring framework with 10 indicators, and a web-based reporting system for countries to report on these indicators. Four of these indicators relate to the cascade of care, in other words, how many people progress through the stages required for effective disease control. “Monitoring the cascade of care helps decision makers pinpoint the greatest gaps in testing, care, and treatment, and allows for measuring progress towards the 2030 targets,” explains Jeffrey V Lazarus, associate research professor at ISGlobal and senior author of the publication.
The problem is that there is no unified approach to define the stages in the HCV cascade of care (CoC). Thus, a group of clinical, epidemiologic, and public health experts from around the world came together to determine which stages should be included, and how they should be defined. The study group agreed to define four essential CoC stages: infected, diagnosed, treated, and cured. They drafted definitions for each stage that would be easily understandable to a broad range of stakeholders.
They then piloted this standardised approach in Denmark, Norway and Sweden, which helped them review and refine the definitions. The approach allowed them to observe, for example, that between 2015 and 2017, the number of people treated increased in Norway, while it declined in Sweden and in the Danish regions studied.
The authors recognise that problems associated with the availability of data and the ways in which data are collected may become apparent when the Consensus HCV CoC is used more widely, including in low-income countries. However, they argue, this approach will help clarify what is being measured when reporting the numbers and proportions of individuals living with HCV who have progressed to diagnosis, treatment, and cure.
“We propose this consensus HCV CoC not as an alternative to the WHO monitoring framework, but rather as a global instrument to facilitate clear and consistent reporting and ensure the accurate monitoring of progress toward the 2030 elimination targets,” stresses Lazarus. “In that sense, it is akin to the three 90s in HIV”.
Safreed-Harmon K, Blach S, Aleman S et al. The Consensus Hepatitis C Cascade of Care: Standardized reporting to monitor progress toward elimination. Clinical Infectious Diseases. 2019. 69: 2218-2227. doi.org/10.1093/cid/ciz714