National Viral Hepatitis Control Program India (National program)
Health outcomes additional info
As per WHO targets
Summary and objectives
This program is launched all over the nation to eliminate viral hepatitis including hepatitis C, B, A and E as per WHO strategy on viral hepatitis elimination defined as a 90% reduction in incidence and a 65% reduction in mortality from existing levels.[
National Viral Hepatitis Control Program (NVHCP)
Ministry of Health and Family Welfare, Government of India on the occasion of the World Hepatitis Day, 28th July 2018, have launched the National Viral Hepatitis Control Program. It is an integrated initiative for the prevention and control of viral hepatitis in India to achieve Sustainable Development Goal (SDG), which aims to achieve the WHO strategy on viral hepatitis elimination, i.e., a 90% reduction in incidence and a 65% reduction in mortality from existing levels.[ This is a comprehensive plan covering the entire gamut from Hepatitis A, B, C, D & E, and the whole range from prevention, detection and treatment to mapping treatment outcomes.
Aims: (i) Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030; (ii) Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepatocellular carcinoma (liver cancer) and (iii) Reduce the risk, morbidity and mortality due to Hepatitis A and E.
1. Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high-risk groups and in hotspots.
2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare
3. Develop standard diagnostic and treatment protocols for management of viral hepatitis and its complications.
4. Strengthen the existing infrastructure facilities, build capacities of existing human resources and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country.
5. Develop linkages with the existing National programs towards awareness, prevention, diagnosis and treatment for viral hepatitis.
6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.
1. Preventive component:
This is the cornerstone of the NVHCP. It includes
1. Awareness generation & behaviour change communication
2. Immunization of Hepatitis B (birth dose, high risk groups, health care workers)
3. Safety of blood and blood products
4. Injection safety, safe socio-cultural practices
5. Safe drinking water, hygiene and sanitary toilets
2. Diagnosis and Treatment:
1. Screening of pregnant women for HBsAg to be done in areas where institutional deliveries are < 80% to ensure their referral for institutional delivery for birth dose Hepatitis B vaccination.
2. Free screening, diagnosis and treatment for both hepatitis B and C would be made available at all levels of health care in a phased manner.
3. Provision of linkages, including with private sector and not for profit institutions, for diagnosis and treatment.
4. Engagement with community/peer support to enhance and ensure adherence to treatment and demand generation.
3. Monitoring and Evaluation, Surveillance and Research
Effective linkages to the surveillance system would be established and operational research would be undertaken through Department of Health Research (DHR). Standardised monitoring & evaluation framework would be developed and an online web based system is established.
4. Training and Capacity Building:
This will be a continuous process and will be supported by NCDC (National Centre for Disease Control), ILBS (Institute of Liver and Biliary Sciences) and state tertiary care institutes and coordinated by NVHCP. The hepatitis induction and update programs for all level of health care workers would be made available using both, the traditional cascade model of training through master trainers and various platforms available for enabling electronic, e-learning and e-courses.
National Viral Hepatitis Control Management Unit
The units at the centre and the states will coordinate the NVHCP.
a. National Viral Hepatitis Management Unit (NVHMU): The NVHMU is established at the centre with in the NHM (National Health Mission) and will be responsible for implementation of program in the country. The NVHMU will be headed by a Joint Secretary who will report to the Mission Director (NHM).
b. State Viral Hepatitis Management Unit (SVHMU)- The State Health Society with nodal officer and required essential manpower will coordinate the program at state level.
c. District Viral Hepatitis Management Unit (DVHMU)- A program officer at the district level from available manpower would act as the nodal person to supervise the program and facilitate the logistics, supply chain, outreach, training at district level.
Of the 28 million population of Punjab (2011 Census), 3.6% are estimated to be positive for anti HCV antibody and 2.6% (728,000) are estimated to test positive for HCV RNA.
The Mukh-Mantri Punjab Hepatitis C Relief Fund (MMPHCRF)
MMPHCRF provided free medical treatment for CHC patients with the goal of eliminating hepatitis C from Punjab from June 18 2016 to 31 August 2018. From 1 september 2018, National Viral Hepatitis Program (NVHCP) replaced the MMPHCRF The Punjab Model is an innovative interactive model of decentralized services using telementoring and algorithm-based treatment with generic drugs. The Punjab Model trains and supports primary care providers (PCPs) to learn emerging treatment options, adverse effects and treatment adherence for managing CHC using the existing health care infrastructure.
Decentralized services were used to treat CHC patients by involvement of PCPs, pharmacists and other team members in district hospitals. The primary hub in this model is the Postgraduate Institute of Medical Education and Research, Chandigarh, India, and 22 district hospitals and 3 university hospitals serve as spokes.
Under MMPHCRF >53,000 hepatitis C patients were treated with success rate >92%.
National Viral Hepatitis Control Programme: The Way forward
The Punjab Model has demonstrated the efficacy of decentralized care in CHC patients and has paved the way for the National Viral Hepatitis Program (NVHCP), which also include hepatitis A, B and E in addition to hepatitis C. The standard National Guidelines for the Diagnosis and Management of Viral hepatitis by the Technical Resource Group was launched on 28th July 2018 by the NVHCP. The decentralized services including ECHO will be used to mentor and support PCPs as part of the national program. The launch of NVHCP in India will ultimately achieve the WHO strategy on viral hepatitis elimination, i.e., a 90% reduction in incidence and a 65% reduction in mortality from existing levels. In Punjab, NVHCP was launched on 1 September 2018 and replaced MMPHCRF.
Injection Safety Project in Punjab
World Health Organization’s global policy on injection safety encourages reduction in unnecessary injections being given for therapeutic purposes, when there is suitable alternative formulation available. In Punjab, unsafe injections are most inportent cause of transmission of hepatitis C & B and HIV.
Based on evidence and the problem of injection safety, an Injection Safety Implementation Project has been rolled out by WHO as a pilot intervention in 3 selected countries – India, Egypt and Uganda.
In India, injection safety campaign and the project was launched on World Hepatitis Day on 28th July 2016. WHO is supporting Union Ministry of Health and Family Welfare, Government of India for implementing the campaign and adapting WHO guidelines on use of safety engineered injection devices (Re-Use Prevention or RUP syringes) in the therapeutic settings.
Unsafe injections have been known to cause blood borne infections like hepatitis B (HBV) and C virus (HCV), and HIV, leading to suffering with high mortality among those affected. Punjab has high prevalence of hepatitis C infection in the range of 3.6 percent against national prevalence rate of 1 percent.
Because of this commitment to address this pertinent public health issue, Punjab is the only state in the country, which has been identified to implement India Injection Safety Implementation Project (2016-18). This project will further complement state government’s initiatives and activities for control of hepatitis C (and other fatal bloodborne infections) through preventing spread of infections to both community and service providers resulting from unsafe and used syringes.
WHO Country Office for India is assisting Directorate of Health & Family Welfare (DHFW), Government of Punjab and other partner institutions like PGIMER to implement project on injection safety in the state.
In all government hospitals in 22 districts, Re-Use Prevention (RUP) syringes have been introduced and replaced the conventional syringes. This is likely to result in reduction in new cases of all 3 infections.