Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
The Toronto Declaration – Where are we now?
Jordan J. Feld MD MPH
Toronto Centre for Liver Disease Sandra Rotman Centre for Global Health
University of Toronto
Strategies to address viral hepatitis globally with specific targets for HBV and HCV, related to:
1. Development National Action Plans 2. Epidemiology 3. Disease Prevention 4. Diagnosis 5. Disease Management
UN Sustainable Development Summit 2015
17 Sustainable Development Goals with 169 ‘targets’ to be achieved by 2030
Hepatitis is on the map!
“They chose to combat the only epidemic that they might actually be able to end”
Dave Thomas, Johns Hopkins
hepatitis ^
WHO Guidelines
To be updated for 2016
Extremely useful tools for all with a focus on resource limited settings
HCV HBV
• 90 Countries represented in Glasgow • Major participation from civil society & people living with hepatitis
New WHO Targets by 2020 1. Prevention
- 90% reduction in new cases of HBV & HCV
2. Treatment - 80% of treatment-eligible individuals with chronic HBV
and HCV treated
3. Mortality - 65% reduction in deaths from HBV & HCV
Gottfried Hirnschall Director, WHO Global Hepatitis Programme
• Medicines Patent Pool expands its mandate to hepatitis C treatment (Nov 2015)
• Hepatitis meds add to the list of Essential Medicines
Improving access to medications
Other countries well on their way • Egypt
– Major progress – Diagnosis & treatment – More to come…
• Mongolia - National Programme on Combatting Viral Hepatitis
Update to the US Department of Health & Human Services Viral Hepatitis Action Plan (March 2015)
By 2020: • Increase in the proportion of persons who are aware of their hepatitis B virus infection, from 33% to 66% • Increase in the proportion of persons who are aware of their hepatitis C virus
infection, from 45% to 66% • Reduce by 25% the number of new cases of HCV infection • Eliminate mother-to-child transmission of HBV
Revisions to the Toronto Declaration 1. The present declaration outlines specific public health policies and interventions with tangible but achievable goals that we hope will help guide WHO and national governments as they continue to develop strategies to address viral hepatitis locally, nationally and ultimately end, not just combat, the epidemic on a global scale. 2. Ensure equitable and prompt access (<6 months) to direct-acting antiviral-based HCV therapy for all patients with advanced fibrosis (F3 or F4) and those with severe extra-hepatic disease (symptomatic cryoglobulinemia, porphyria cutanea tarda, lymphoma) or other urgent reasons for therapy
2. Ensure equitable and universal access to direct-acting antiviral-based HCV therapy for all patients with HCV infection
• Therapy should be made available immediately (within 6 months) for all individuals with advanced fibrosis (F3 or F4) and those with severe extra-hepatic disease (symptomatic cryoglobulinemia, porphyria cutanea tarda, lymphoma) or other urgent reasons for therapy
• Develop a clear strategy for universal treatment access for all individuals with
HCV infection regardless of disease stage and without limitations based on drug/alcohol use, with defined plans for local/regional HCV elimination
Putting it into action • Quebec
– 2015 - Access to those with F3/F4 or extra-hepatic manifestations
– 2016/17 – Expand to include F2 and higher – 2018 – Access for all infected individuals
• Helpful for clinicians and individuals living with HCV • We would like to treat everyone immediately, but at
least knowing when you will be treated is very helpful for those without ‘urgent’ need for treatment now