Malik, F;
Bailey, H;
Chan, P;
Collins, IJ;
Mozalevskis, A;
Thorne, C;
Easterbrook, P;
(2021)
Where are the children in national hepatitis C policies? A global review of national strategic plans and guidelines.
JHEP Reports
, Article 100227. 10.1016/j.jhepr.2021.100227.
(In press).
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Abstract
Background and Aims: It is estimated that 3.26 million children and adolescents worldwide have chronic hepatitis C virus (HCV) infection. To date, the global response has focussed on the adult population, but Direct Acting Antiviral (DAA) regimens are now approved for children aged ≥ 3 years. This global review describes the current status of policies on HCV testing and treatment in children, adolescents and pregnant women in WHO Member States. / Methods: We identified national strategic plans (NSPs) and/or clinical practice guidelines (CPGs) for HCV infection from a World Health Organization (WHO) database of national policies from member states as of August 2019. A standardised proforma was used to abstract data on polices or recommendations on testing and treatment in children, adolescents and pregnant women. Analysis was stratified according to the country-income status and results were validated through WHO regional focal points through August 2020. / Results: National HCV policies were available for 122 of the 194 WHO Member States. Of these, the majority (n=71/122, 58%) contained no policy recommendations for either testing or treatment in children or adolescents. Of the 51 countries with policies, 24 had specific policies for both testing and treatment, and were mainly from the European region; 18 countries for HCV testing only (12 from high- or upper-middle income); and 9 countries for treatment only (7 high- or upper-middle income). Twenty-one countries provided specific treatment recommendations: 13 recommended DAA-based regimens for adolescents ≥12 years and six still recommended interferon/ribavirin-based regimens. / Conclusions: There are significant gaps in policies for HCV-infected children and adolescents. Updated guidance on testing and treatment with newly approved DAA regimens for younger age groups is needed, especially in most affected countries.
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