Global Treatment Coverage of Hepatitis B Lagging

Despite reductions in the costs of antiviral medications effective against hepatitis B virus (HBV) infection, global treatment coverage of HBV remains low, according to the CDC’s Morbidity and Mortality Weekly Report.

In assessing global progress in access to hepatitis B treatment in 2016, the authors found that improved access to effective HBV medications is needed to scale up treatment coverage among individuals with the virus, particularly in countries with a high disease burden.

An estimated 257 million individuals are living with chronic HBV infection, according to the report. Among these individuals, an estimated 27 million had received a diagnosis and were aware of their infection in 2016, and 4.5 million were estimated to be receiving HBV treatment.

The researchers indicated that treatment coverage was consistently low across countries in all income strata, but highest (22%) in upper-middle income countries.

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In 2017, all low- and middle-income countries (LMICs) could legally procure generic entecavir, and all but 2 LMICs could legally procure generic tenofovir. The median cost of WHO-prequalified generic tenofovir fell from $208 per year in 2004 to $32 per year in 2016, the researchers noted. In 2015, the lowest reported price of entecavir was $427 per year of treatment.

The authors found treatment coverage to be highest in the Western Pacific region and upper middle-income countries. Africa, which has among the highest prevalence of HBV infection and highest mortality from liver cancer, was noted to have no national programs established to provide testing, care, and treatment services for all individuals with HBV infection.

A 90% reduction in incidence and 65% reduction in mortality are needed to reach the goals for elimination of the virus worldwide by 2030, according to the report. Taking advantage of the availability of generic antivirals effective in treating HBV infection could further increase access to treatment and assist in moving toward elimination targets.

The authors suggested that increased access to generic HBV medications through price reductions and the development of a national viral hepatitis control strategy, particularly in countries with a high disease burden, are essential to improving treatment coverage.

“Greater community awareness and better understanding of the national disease burden, access to and availability of affordable diagnostics, and trained providers are needed to promote increased access to care,” the authors wrote.

References

Hutin Y, Nasrullah M, Easterbrook P, et al. Access to treatment for hepatitis B virus infection — Worldwide, 2016. MMWR. 2018. https://www.cdc.gov/mmwr/volumes/67/wr/mm6728a2.htm?s_cid=mm6728a2_w.