National Hepatitis Elimination Profile for Pakistan: Key Takeaways

National Hepatitis Elimination Profile for Pakistan: Key Takeaways

In 2021, the Coalition for Global Hepatitis Elimination (CGHE) launched the National Hepatitis Elimination Profile (N-HEP) Initiative to accelerate progress towards hepatitis elimination. These profiles compile key information related to epidemiological burden of disease, status of program delivery, and the policy environment for essential components of a hepatitis elimination program.  In July 2021, 6 profiles in the Americas were launched. On June 9th, 2022,  the Pakistan profile was launched. In this article, key takeaways of the Pakistan National Hepatitis Elimination profile are noted: 

Pakistan’s hepatitis elimination strategy is out of date; however, hepatitis elimination targets have been set

The Pakistan’s National Hepatitis Strategic Framework (2017-2021) is now out of date. Pakistan has 2030 elimination goals for both hepatitis B (HBV) and hepatitis C (HCV). The Prime Minister has set a target to screen 50% of the eligible population, aiming to reach 69 M persons with anti-HCV screening and 5.15 M with PCR confirmation testing between July 2020 and June 2025. In addition, in July 2019, the Prime Minister announced an ambitious program for HCV Elimination to treat 9.8 million HCV patients by 2030, which is awaiting funding to start.

There is a high burden of Hepatitis B and C in Pakistan

Pakistan has the second highest burden of HCV with 9.8 million people living with chronic HCV. The greatest risk factors for HCV transmission include blood transfusions (15%), history of hospitalization (14%), dental treatment (13%), use of injections (12%), and history of surgery (9%). The national prevalence of HBV in Pakistan was 2.5% in 2008. From 2015 to 2019, there was a 5% increase in HCV-related deaths and an 8% increase in HBV-related deaths. 77% of infants received the 3 dose HepB vaccine series in 2020, which did not meet the WHO 2020 target of 90%. Pakistan has achieved the 2020 Sustainable Development Goal target of a prevalence of HBV in children under 5 years of age under 1%. 

Key challenges to hepatitis elimination include a lack of coordination across provinces and lack of screening

The availability of hepatitis information and access to hepatitis care varies from province to province. No national prevalence studies have been conducted since 2008; however, studies were conducted for the Punjab province (2018) and Sindh province (2019) recently. Although Pakistan has a national policy for HBV vaccination, the birth dose is not available across all provinces. There is a lack of coordination across federal, provincial, and local governments. There is also a lack of effective monitoring and evaluation of the provincial hepatitis control programs. 

In addition, approximately half of all blood donors are not screened for HCV, HBV, and HIV.. General population screening implementation has been challenging, and a scale-up of point-of-care testing is needed. HCV NAT and antigen testing remain expensive.    

Pakistan has made progress towards addressing challenges and toward its hepatitis elimination goals

The COVID-19 response has led to a large increase in the capacity for PCR testing, electronic health reporting, and improved coordination across provinces and the federal capital. Some provinces have begun to report the number of persons diagnosed and treated with HBV/HCV. GeneXpert machines have been approved for HBV and HCV viral load testing and are recommended for use in the national guidelines. Anti-HCV and HBsAg testing are available free-of-charge in the public sector. Free HBV treatment is available at public district hospitals and tertiary centers, and free HCV treatment is available in the public sector. 

The country has a Corporate Coalition for Viral Hepatitis Elimination in Pakistan (CCVHEP) made up of 12 leading companies to support the Government of Pakistan’s effort to eliminate viral hepatitis in Pakistan by 2030. There are also a number of successful HCV micro-elimination programs running in the country, both in the public and private sector. In addition, the Nai Zindagi Trust in Pakistan provides syringes to at least 70% of PWID in a given geographical boundary. 

Next steps to reach hepatitis elimination

Some of the next steps for hepatitis elimination in Pakistan include: 

  • Update the National Strategic Framework for the next period of implementation
  • Improve surveillance of viral hepatitis B and hepatitis C by updating case definitions
  • Increase hepatitis B birth dose vaccination nationally by introducing catch-up vaccination for children older than 5 years old and for populations at-risk
  • Increase HCV testing and treatment by building on early micro-elimination programs, engaging with community-based organizations, and decentralizing HCV treatment to health centers and basic health units