IAPAC Supports Formation of UN Group of Friends for Hepatitis Elimination

Statement by Dr. José M. Zuniga, President/CEO, IAPAC and Fast-Track Cities Institute

20 September 2022 – UNGA Side Event: Building Solidarity for Hepatitis Elimination

Thank you for inviting me to join you for this United Nations General Assembly side event focused on building solidarity for hepatitis elimination. I wish I could be with you in New York City, but I am grateful to the Coalition for Global Hepatitis Elimination and the Task Force for Global Health for making my virtual participation possible.

For reference, the International Association of Providers of AIDS Care (IAPAC) is a global medical association representing more than 30,000 clinicians delivering care and treatment services for people living with HIV and comorbid diseases, including viral hepatitis. We are also the core technical partner to the Fast-Track Cities network, which numbers more than 400 cities and municipalities. These cities and municipalities are also supported by the Fast-Track Cities Institute through implementation science and operational research activities. While at its launch in 2014 the Fast-Track Cities network was initially focused on ending urban HIV epidemics with some cross-over into addressing TB coinfection, in 2019 the network’s mandate was expanded to ending urban TB irrespective of coinfection as well as embracing and urbanizing the WHO’s goals of eliminating HBV and HCV by 2030.

Our mandate’s expansion into urban HBV and HCV responses was a natural evolution for two reasons: First, given the significant advances in HIV treatment, we have the tools to guarantee people living with HIV near-normal lifespans. Why then would we wish for them to succumb to comorbid diseases and syndemic conditions? And, second, why not leverage the HIV response to facilitate greater progress in closing gaps across HBV and HCV care continua, for example? Given progress is sadly lagging to the detriment of millions of people, and because a high tide can lift all boats, we have been leveraging the HIV response across the Fast-Track Cities network to accelerate urban HBV and HCV responses.

Are we succeeding? We have been monitoring, collecting, and disseminating best practices from urban viral hepatitis elimination efforts that we posit are innovative, replicable, and scalable. Here are three examples:

  • Our Fast-Track Cities colleagues in Lisbon are using community pharmacies to offer point-of-care tests for HIV, HBV, and HCV infections to expand opportunities to diagnose these three diseases outside of clinical settings, which some who accessed the testing viewed as stigmatizing.
  • In Madrid, our colleagues have implemented an HIV/HCV screening program with embedded linkage to a care nurse, thus actioning differentiated service delivery in an attempt to both optimize care since, as a rule, nurse-delivered care tends to be much more person centered, and strategically expand the health workforce engaged in HCV care. Notably, the quality of care did not suffer. Indeed, only 3% of those diagnosed with HCV were lost to follow-up.
  • And, in Amsterdam, our colleagues are offering testing and linkage to HCV care to clients attending homeless services as a means of conducting outreach to a hard-to-reach at-risk population. Most recent data indicate 71% of homeless people who inject drugs linked to care and 57% initiating treatment.

These are but a few examples of the urban public health leadership on display in cities and municipalities around the world, from Bangkok to Kigali and New York City to Tel Aviv. Yet, these cities and municipalities alone cannot achieve the global goals of eliminating HBV and HCV.

The new World Health Organization (WHO) Global Health Sector Strategy calls for 90% of people living with HCV to be diagnosed and of those 80% to be on treatment. My concern is that the baseline (based on 2020 data) is 30% for diagnosis and 30% on-treatment. Similarly progress towards the ambitious HBV targets when compared against baseline also reflects a need to re-focus and accelerate our efforts to eliminate HBV. Those are significant gaps requiring business unusual. In fact, we need a whole of government (including city and municipal governments) and whole of society approach, and I believe that it is in our cities and municipalities where we can be the most innovative, responsive, and timely efforts to curb morbidity and mortality related to HBV and HCV.

Bottomline, though, achieving the global goals HBV and HCV elimination requires political leadership at all jurisdictional levels, and most notably national levels, with national investments to match and adequate to the task at hand. Many countries, such as India and Egypt, and, as already noted, many cities and municipalities, are already taking bold actions, including through interventions ranging from timely administration of birth dose HBV vaccination to scaling up access to diagnostic tests and direct-acting antivirals to treat and cure HCV. But more can and must be done to avert millions of unnecessarily premature HBV- and HCV-related deaths by 2030. In fact, given the reality we have a cure for HCV, it is a public health failure of a colossal magnitude that we are not more rapidly closing gaps across the HCV continuum and thus failing to cure millions of people.

What is needed today is a re-commitment by UN member-states to work in solidarity in this common cause. That is why IAPAC and the Fast-Track Cities Institute unequivocally support the formation of a UN Group of Friends focused on attaining the attainable goal of hepatitis elimination.