Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study

PLOS ONE, Nov 2019

Background and aims In the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat. Methods Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country. Results Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly. Conclusion The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere.

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Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study

January Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study Kelly Safreed-Harmon 0 1 2 3 Kristina L. Hetherington 0 1 3 Soo Aleman 0 1 3 Hannu Alho 0 1 3 Olav Dalgard 0 1 3 Tove Frisch 0 1 3 Magnus Gottfredsson 0 1 3 Nina Weis 0 1 3 Jeffrey V. Lazarus 0 1 2 3 on behalf of the Hep-Nordic Study Group 0 1 3 0 In the Nordic countries (Denmark , Finland, Iceland , Norway , Sweden), the prevalence of 1 Competing interests: Jeffrey Victor Lazarus , Kelly Safreed-Harmon, and Kristina L. Hetherington 2 CHIP, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark , 2 Barcelona Institute for Global Health (ISGlobal), Hospital ClÂõnic, University of Barcelona , Barcelona , Spain , 3 Department of Infectious Diseases, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden, 4 Abdominal Center, Helsinki University Hospital , Helsinki , Finland , 5 Department of Infectious Diseases, Akershus University Hospital , Lørenskog, Norway, 6 RiksfoÈ reningen Hepatit C, Månkarbo , Sweden , 7 Faculty of Medicine, School of Health Sciences, University of Iceland , Reykjavik , Iceland , 8 Department of Internal Medicine, Division of Infectious Diseases, Landspitali University Hospital , Reykjavik , Iceland , 9 Department of Infectious Diseases, Copenhagen University Hospital , Hvidovre , Denmark , 10 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark 3 Editor: Yury E. Khudyakov, Centers for Disease Control and Prevention , UNITED STATES chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country. - Data Availability Statement: All relevant data are within the paper and its Supporting Information file. Funding: Funding was provided by Gilead Sciences (212010336) to Jeffrey Victor Lazarus, Kelly Safreed-Harmon, and Kristina L. Hetherington. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Background and aims public health threat. Methods Results Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to received funding from Gilead Sciences, a commercial company. There are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials. anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly. Conclusion The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere. Introduction An estimated 71 million people worldwide have chronic hepatitis C virus (HCV) infection, including 14 million people in the World Health Organization (WHO) European Region. [ 1,2 ] In this region, HCV causes more than 100,000 deaths annually. [3] Nearly 3.3 million people in the countries of the European Union are living with chronic HCV infection. [ 4 ] People who inject drugs (PWID), including those who inject currently and those who have done so in the past, are the primary group affected by HCV in Europe. The incidence and prevalence of HCV infection remain high among PWID in most countries, while access to prevention and harm reduction services varies widely. [3,5±7] Approximately 43% of the 1.2 million PWID in the European Union/European (...truncated)


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Kelly Safreed-Harmon, Kristina L. Hetherington, Soo Aleman, Hannu Alho, Olav Dalgard, Tove Frisch, Magnus Gottfredsson, Nina Weis, Jeffrey V. Lazarus, on behalf of the Hep-Nordic Study Group. Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study, PLOS ONE, 2018, Volume 13, Issue 1, DOI: 10.1371/journal.pone.0190146