Increasing hepatitis treatment to the levels required for elimination will require substantial scale up of HBV and HCV testing to expand the pool of individuals who are diagnosed and can be linked to care.  However, in 2017, more than 85% of the approximately 324 M persons living with HBV and HCV were unaware of their infection.

To overcome this diagnosis challenge, known as the “Missing Millions,” countries will have to develop appropriate testing policies, technologies and implementation strategies to ensure elimination is programmatically and economically feasible. Ultimately, scale up of hepatitis testing will require a mix of laboratory and point-of-care based testing services which have different pros and cons in terms of throughput and accessibility. Planning and implementation of the most efficient and cost-effective mix of hepatitis testing technologies is dependent on the epidemiologic situation, the current capacity for laboratory and point of-care testing, and the education and skills of clinicians and outreach workers.  

CGHE is launching the HEAT (Hepatitis C Evaluations to Amplify Testing and Treatment) project to support HCV elimination programs in developing elimination-ready testing policies and strategies.

This project will offer programs the following types of support and technical assistance:

1. Evaluation of hepatitis context: At the national or sub-national level, in collaboration with local officials, CGHE will support an expert review of epidemiologic data, assess current hepatitis program plans including testing policies, and conduct an analysis of laboratory –based and point-of-care testing capacity.  If the program has not conducted this assessment previously, then this analysis is necessary as the basis for developing an appropriate scale-up strategy.
2. Model the best scale-up strategy: Based on the context assessment, a new web-based tool, the Hep C Elimination Tool, developed by Dr. Jag Chhatwal at Harvard Medical School, will be used to estimate the HCV testing volume needed to reach program targets and the best mix of laboratory-based and point of care testing as necessary to achieve these goals. See examples of Dr. Chhatwal testing modeling in this previous study in Pakistan: JAMA Netw Open. 2019 May 3;2(5):e193613). The Hep C Elimination Tool will be made available online at www.globalhep.org
3. Update of local policies:  As needed, CGHE will assist programs in drafting updated plans and policies to reflect the required efforts for scale-up, including selecting appropriate target populations, recommending the balance of lab vs point of care platforms, establishing required annual targets, and drafting monitoring and evaluation frameworks.
4. Build Local Coalitions: If not already established, CGHE will assist in convening a local coalition of public and private partners to build collaborations among health officials, clinicians and civil society that would oversee both the development and eventual implementation of the strategy.
5. Sustainable partnership: CGHE will create a sustainable partnership with programs participating in the HEAT project by including them in the wider Coalition community of practice. Opportunities for sustained partnership include country-to-country learning collaboration with more advanced elimination programs and CGHE providing further TA in technical writing and dissemination of program experiences.

CGHE wishes to support hepatitis programs at varying stages of elimination planning and from diverse geographic areas.

Important factors for success include:

• Demonstration of political will to initiate and actively support the evaluating of testing policies and strategies;
• Engagement of a broad network of local stakeholders (i.e., officials from different government Ministries, public and private organizations, patient groups of those affected by hepatitis;
• Support of participatory planning for elimination scale-up activities

If your program is interested in being apart of this project, please fill out this web-form by February 29th.

Photo source: Ashleigh, Conor, from Iran. Submitted to CGHE Photo Contest 2019