Professor Dr Rosmawati Mohamed

Consultant Hepatologist, University Malaya Medical Centre.

Co-chairperson, WHO Strategic and Technical Advisory Committee for Viral Hepatitis (STAC-Hep)

Executive Council and Founding Member , Coalition to Eradicate Viral Hepatitis in Asia Pacific

Elimination of Viral Hepatitis – National Coordinated Action

2

3

Estimated annual deaths by region

(from the Global Burden of Disease Study (GBDS)

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Asia Pacific Americas Europe Africa & ME

Num

ber

of

death

s/y

ear

Viral hepatitis HIV TB Malaria

Global Burden of Disease Study Lancet 2012

Asia Pacific 1,012,873 deaths per year

(70% of the total worldwide mortality

From viral hepatitis)

Rest of World 431,681 deaths per year

viral hepatitis is a bigger threat to the Asia-Pacific population compared to HIV

4

4

Death rate from viral hepatitis is

3x as high as HIV/AIDS

Viral Hepatitis Tuberculosis HIV/AIDS Malaria

1,012,873

304,628

827,567

106,729

Total Asia Pacific

Mortality Figures

Global Burden of Disease Study Lancet 2012

WHO budget allocation

International Federation of Pharmaceutical Manufacturer s and Associations

6

Hep B immunization

Blood/injection safety

Outbreak control

Water and sanitation

2010 2011 2012 2013 2014

World Health

Assembly

1st Resolution

on

Viral Hepatitis

WHO

Executive

Board

resolution

Formation of

STAC-Hep

Establishment

of Global

Hepatitis

Programme

(GHP)

Reorganization

of Global

Hepatitis

Programme

2015 (and beyond)

Implementation

of Resolution

And

Global Action

Plan

Global

Framework

This resolution called upon governments to incorporate specific policies, strategies and tools

to reduce the burden related to viral hepatitis

WHO's work in the area of Hepatitis:

Viral Hepatitis is a significant global health issue:

7

Hep B immunization

Blood/injection safety

Outbreak control

Water and sanitation

WHO's work in the area of Hepatitis:

evolution…

2010 2011 2012 2013 2014

World Health

Assembly

Resolution on

Viral Hepatitis

Establishment

of Global

Hepatitis

Programme

(GHP)

Reorganization

of Global

Hepatitis

Programme

2015 (and beyond)

Global

Hepatitis

Framework

-The framework is provided as a guide to

governments on developing effective

national action plans to prevent and control

viral hepatitis

WHO

Executive

Board

resolution

Formation of

STAC-Hep

Implementation

of Resolution

And

Global Action

Plan

Cohesive approach to address issues on viral hepatitis

“My Commitment to Cure” Coalition is inspired and dedicated to voice and drive a comprehensive national plan to raise awareness, enhance detection and care of patients living with viral hepatitis, focussing on Hepatitis C, with the ultimate objective of eliminating hepatitis C in Malaysia.

Mission statement

MY COMMITMENT TO CURE Coalition A group of clinicians (with an interest in viral hepatitis) coming together

• to raise awareness on the burden and consequences of Hepatitis C infection,

• to educate on the benefits of early detection and the importance of linkage to care.

• to work in partnership with relevant stakeholders in formulating and promoting strategies and key action plans towards Hepatitis C elimination

Membership ( 8 pax: 6 Ministry of Health, 2 Uni, )

Professor Rosmawati Mohamed (Chairperson) • Co chair of WHO STAC-HEP • Consultant Hepatologist at University of Malaya Medical Centre

Datuk Dr Muhammad Radzi Hassan • Head of Service for Gastroenterology, Ministry of Health Malaysia • Consultant Gastroenterologist, Hospital Sultanah Bahiyah

Dr Tan Soek Siam • Head of Service for Hepatology, Ministry of Health Malaysia • Consultant Hepatologist, Hospital Selayang, Selangor

Dr Haniza Omar • Consultant Hepatologist, Hospital Selayang, Selangor

Assoc.Prof. Dr Hamizah Razlan • Consultant Gastroenterologist, National University Malaysia Medical Center

Dr Hjh Rosaida Md Hj Said • Consultant Gastroenterologist, Head of Medical Department, Hospital Ampang, Kuala

Lumpur Dr Tee Hoi Poh

• Consultant Gastroenterologist, Hospital Tuanku Ampuan Afzan, Kuantan, Pahang. Dr Saravanan Arjunan

• Consultant Gastroenterologist, Hospital Kuala Lumpur

World Hepatitis Day, Malaysia 2011 26 participating centres 12 Ministry of Health (MOH) hospitals,

4 private medical centres,

3 Universities/university hospitals

Main Venue:

Sunway Pyramid

Shopping Mall

16-17th July 2011

World Hepatitis Day Campaign 2012 20 participating centres 13 Ministry of Health (MOH) hospitals,

3 private medical centres,

3 University hospitals

Main Venue:

One Utama Shopping

Mall

27-29 July 2012

“My Commitment to Cure” – Milestones

1 Jun 2014

May 2015 Jan 2016

Got together as a Coalition

My COMMITMENT to Cure Launch and roadshow

(14-17.5.15) pledge campaign

Jul 2015

Brainstorming & promote development of strategic road map

for Hepatitis C Aug 2014 – April 2015

Nationwide communication of strategic road map/key action plans

Start from July 2015 – to coincide with National celebration of World Hepatitis Day

2015 – and going

1st Coalition Meeting

23rd August 2014

2nd Coalition Meeting

13 Dec 2014

3rd Coalition Meeting

14 Feb 2015

4th Coalition Meeting 19Apr2015

A Nationwide drive to pledge support for Hepatitis C Each pledge represents a commitment to raise awareness and action to help those living with hepatitis C

451,000 represents the estimated number of Malaysians living with chronic Hepatitis C

www.mycommitment2cure.com.my

“My Commitment to Cure” – Major Milestones

1 Jun 2014

May 2015 Jan 2016

Got together as a Coalition

My COMMITMENT to Cure Launch & pledge campaign

Jul 2015

Brainstorming & promote development of strategic road map

for Hepatitis C

Aug 2014 – May 2015

Nationwide communication of strategic road map/key action plans

Start from July 2015 – to coincide with National celebration of World Hepatitis Day

2015 – and going

1st Coalition Meeting

23rd August 2014

2nd Coalition Meeting

13 Dec 2014

3rd Coalition Meeting

14 Feb 2015

4th Coalition Meeting 19Apr2015

Goal : to promote development of a strategic road

map to drive the Hepatitis C response in Malaysia

KEY ACTION PLANS Our Hepatitis C Strategy in Malaysia at a Glance

Pillars of the Strategic framework with Key Action Plans Po

siti

on

ing

th

e H

CV

resp

on

se

Op

tim

isin

g H

CV

dete

ctio

n a

nd

care

Sto

pp

ing

HC

V t

ran

smis

sio

n

Cre

ati

ng

an

en

ab

lin

g e

nvi

ron

men

t

Targets

Understanding the

current

epidemiology in

Malaysia

Establish disease

burden and impact

of HCV

National Hepatitis C

Registry

Action Plans

Strengthen

collection of HCV

data

Estimate the disease

burden and

economic impact of

HCV

Advocate and

facilitate a

comprehensive

surveillance strategy

Targets

Scale-up on HCV

detection

HCV diagnostic

protocols

Optimal referral

pathways

HCV care and

treatment guidelines

Action Plans

HCV testing and

education

Recommend

standardised

algorithms for HCV

diagnosis

Facilitate linkage of

care for diagnosed

HCV cases

Adopt and adapt the

WHO HCV

guidelines

Targets

Promote safe health

care standards and

tools in HCV

prevention plans

Action Plans

Work with relevant

partners to

strengthen HCV

prevention

measures in health

care

Targets

Mark World

Hepatitis Day

Forming stakeholder

partnerships and

collaborations

Comprehensive

National Hepatitis

Action Plans for

Hepatitis C

Action Plans

Organise and plan

activities for World

Hepatitis Day to

increase awareness

and provide

education on HCV

Multi-faceted

stakeholder

partnership

particularly with

MOH

HCV: Hepatitis C virus; IDU: injection drug users; MOH: Ministry of Health; WHO: World Health Organisation

Four Axes of the WHO Global Hepatitis Framework:

Axis 1: Partnerships, resource mobilization and communication

Axis 2: Data for policy and action

Axis 3: Prevention of virus transmission

Axis 4: Screening, care and treatment

Four Axes of the WHO Global Hepatitis Framework:

Axis 1: Partnerships, resource mobilization and communication 4. Creating an enabling environment Axis 2: Data for policy and action

1. Positioning the HCV response

Axis 3: Prevention of virus transmission 3. Stopping HCV transmission

Axis 4: Screening, care and treatment 2. Optimising HCV detection and care

KEY ACTION PLANS The Hepatitis C Strategy in Malaysia at a Glance

Pillars of the Strategic framework with Key Action Plans Po

siti

on

ing

th

e H

CV

resp

on

se

Op

tim

isin

g H

CV

dete

ctio

n a

nd

care

Sto

pp

ing

HC

V t

ran

smis

sio

n

Cre

ati

ng

an

en

ab

lin

g e

nvi

ron

men

t

Targets

Understanding the

current

epidemiology in

Malaysia

Establish disease

burden and impact

of HCV

National Hepatitis C

Registry

Action Plans

Strengthen

collection of HCV

data

Estimate the disease

burden and

economic impact of

HCV

Advocate and

facilitate a

comprehensive

surveillance strategy

Targets

Scale-up on HCV

detection

HCV diagnostic

protocols

Optimal referral

pathways

HCV care and

treatment guidelines

Action Plans

HCV testing and

education

Recommend

standardised

algorithms for HCV

diagnosis

Facilitate linkage of

care for diagnosed

HCV cases

Adopt and adapt the

WHO HCV

guidelines

Targets

Promote safe health

care standards and

tools in HCV

prevention plans

Action Plans

Work with relevant

partners to

strengthen HCV

prevention

measures in health

care

Targets

Mark World

Hepatitis Day

Forming stakeholder

partnerships and

collaborations

Comprehensive

National Hepatitis

Action Plans for

Hepatitis C

Action Plans

Organise and plan

activities for World

Hepatitis Day to

increase awareness

and provide

education on HCV

Multi-faceted

stakeholder

partnership

particularly with

MOH

HCV: Hepatitis C virus; IDU: injection drug users; MOH: Ministry of Health; WHO: World Health Organisation

Methods Multi-parameter evidence synthesis methods were applied to combine all available relevant data sources - both direct and indirect - that inform the epidemiological parameters of interest.

To address the data shortage in the epidemiology of Hepatitis C BMC Infectious Diseases 11/2014

An estimated 2.5% of the adult population are Hepatitis C positive, of whom 59% (95% CrI: 50–68%) acquired their infection through injecting.

Global prevalence of HCV infection, adults (19-49 years)

Global Burden of Disease Study Mohd Hanafiah K, et al. Hepatology 2013 Apr;57(4):1333-1342.

Global: 130-170 million Asia: 49-64 million

• Our estimated prevalence of 2.5% (in persons aged 15-64 years) is consistent with the findings of the 2010 Global Burden of Disease (GBD) study

• Within the countries of the WHO Western Pacific Region (WPR), Malaysia occupies an upper tier in terms of HCV prevalence; prevalence of 3.2% in China

Sievert W, et al. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int 2011 Jul;31 Suppl 2:61-

80.

Data on Hepatitis C Disease burden estimate is lacking

Po

siti

on

ing

th

e H

CV

resp

on

se

Dat

a fo

r p

olic

y an

d a

ctio

n

•Current epidemiology and genotype data in Malaysia

•Estimating the disease burden

•Notification •Disease registries

•Planning a comprehensive surveillance strategy

•Data on treatment

•Impact assessment tools

•Health economics and outcomes research

•Forming a roadmap and Action plans

•Formulating policies

Disease burden estimate 1. Data from Global Burden of Disease Study that was published in 2010

Source: Malaysia Global Burden of Disease study 2010 (GBD 2010) Result 1990-2010. Global Burden of Disease Study 2010 – Malaysia Results by Cause 1990-2010. [Date accessed: 2 September 2014], Available from: http://ghdx.healthdata.org/record/malaysia-global-burden-disease-study-2010-gbd-2010-results-1990-2010

*disability-adjusted life-years (DALY)

2. Projections of the current and future disease burden of hepatitis

C virus infection in Malaysia.

Health Outcome Death DALY*

Acute HCV 16.574 (10.7624-26.2466) 634.09 (404.589-951.239)

Cirrhosis of liver secondary to hepatitis C 566.566 (464.108-725.255) 14 792.9 (12207.9-19092.6)

Liver cancer secondary to hepatitis C 771.221 (610.224-957.869) 17 073.7 (13621.2-21632.4)

Total 1354.361 32 500.69

23

Our Hep C disease burden is high and forecasted to rise steeply over the coming decades

Projections of severe HCV-related disease from modelling exercises

(Hutchinson et al., 2005, Hepatol.)

An age-structured multi-state Markov model was developed to simulate the natural history of HCV infection.

2015

Similar to other studies which show rising Hep C disease burden

25

•Title: Strengthen Data Collection,

Enhance Hepatitis C Detection, and

Linkage to Care

• Date: October 29, 2014

• Overview

–The objective of this full day seminar is to strengthen the

collection and use of hepatitis C surveillance data,

facilitate identification of those at high risk for Hepatitis C

and provide better linkage to care so effective treatment

can be offered

Time Topic Speaker

8.00am – 9.00am Registration

9.00am – 9.30am Establishing the urgency: Hepatitis C Epidemiology and its consequences

Dr Tan Soek Siam

9.30am – 10.00am What screening/surveillance data is available for Hepatitis C? Datuk Dr Muhammad Radzi Hassan

10.00am – 10.30am HCV Testing Algorithm and reporting Datin Salbiah (Microbiologist)

10.30am – 11am Coffee Break

11.00am – 11.30am HCV screening by Family Medicine Specialists Dr. Baizury Bashah

11.30am – 12.30pm Discussion (Panellists: Prof Dr. Rosmawati Mohamed, Datuk Dr Jeyaram, Dr Rosemi, Dr Ahmad Shukri)

12.30pm – 2.00pm Lunch

2.00pm – 2.30pm HCV Notification Public Health Division, Ministry of Health

2.30pm – 3.00pm How can we improve the HCV data collection and link this to a national registry?

Public Health Division, Ministry of Health

3.00pm - 3.30 pm Linkage to care of HCV positive cases Dr Tee Hoi-Poh

3.30pm - 5.00 pm Discussion (Panellists: Datuk Dr Muhammad Radzi Hassan, Dr Haniza, Dr Rosaida, A/Prof Hamizah, Dr Saravanan)

Tea

HCV seminar to plan a screening programme, comprehensive surveillance strategy, diagnosis and linkage to care (family medicine specialists, public health

experts, clinical microbiologists, blood bank)

29 Oct 2014

Government Leadership generates the most effective rsponse, we proposed the formation of a

Technical Working Group to discuss

NATIONAL STRATEGIC PLAN FOR VIRAL HEPATITIS

Ministry of Health (MoH) workshop

25-27 February 2015

Disease Control Division, MoH

Disease Control Division, MoH

Catalyst for development of a National Strategic Plan for Viral Hepatitis

Adoption of 2nd resolution on viral hepatitis ( by World Health Assembly 67.6) in 2014

- reaffirmed the commitment of Member States to enhanced action on hepatitis

Viral Hepatitis featured the proposed Post 2015 Health and Development Goal

- Goal 3: 3.3 – By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, WBD and other CD

Disease Control Division, MoH

NATIONAL STRATEGIC PLAN ON VIRAL HEPATITIS

- nearly ready

Challenge: “Costed” Strategy (Disease Control /Public Health Division is in charge of the National Strategic Plan, but need to set up a meeting with Medical Development Division for funding lab diagnostics, treatment, screening programme)

Op

tim

ise

pre

ven

tio

n, S

cre

en

ing,

car

e a

nd

tre

atm

en

t • Screening and counselling resource package

• Notification

• Optimal referral pathways

• Care and treatment guidelines

• National care policy/plans

• Equity in access to treatment and drugs

• Forming a roadmap and Action plans

Snapshot of

Hepatitis C

Booklet to heighten awareness on the extent of Hepatitis C disease burden among policy makers

will be finalized for consideration by the 69th World Health Assembly in May 2016

Conclusions:

• Increasing awareness of burden related to viral hepatitis, particularly Hepatitis C

• Comprehensive national response to viral hepatitis will require more visibility and resources

Thank You