AFEW Chairman Becomes HCV Change Maker

Board Chair of AFEW International Jeffrey V. Lazarus has recently become one of the 2017 HCV Change Makers from the Economist Intelligence Unit (EIU). The Change Makers programme recognises 18 Hepatitis C Virus (HCV) innovators doing exemplary work in the programme’s three thematic areas: multi-stakeholder approaches; screening; and technology. Their ground-breaking efforts can inspire and guide their peers on the path to HCV elimination. The programme also aims to spark debate and action on HCV policy and access to care.

AFEW‘s Board Chair is awarded for his work in technology. Being the associate researcher at the Barcelona Institute for Global Health, Hospital Clínic, and affiliated professor at the Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Jeffrey Lazarus leads a large-scale digital survey of Hepatitis C patients in Europe. Together with leading stakeholders, Prof Lazarus and his colleagues now plan to repeat the survey on a regular basis, ensuring alignment with the objectives of the WHO Global Health Sector Strategy on Viral Hepatitis.

“The EIU changemaker award is a great recognition of the importance of involving patients in the hepatitis prevention, treatment and care that they need and deserve. My colleagues and I will continue to look for ways to further this agenda,” Jeffrey Lazarus is saying.

Hep-CORE’s 39 questions ask about national coordination, disease monitoring, prevention, testing and treatment. Among them: In your country, are there any HCV testing/screening sites outside of hospitals for the general population? In your country, is there a clear linkage-to-care mechanism so that people who are diagnosed with Hepatitis B and C are referred directly to a physician who can manage their care? Prof Lazarus and his team used Research Electronic Data Capture, an open-access web-based online data collection tool, to design the survey.

Hepatitis A Prevails in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

Hepatitis Prevention Month to commemorate the World Hepatitis Day was organised for the first time in the history of Kyrgyzstan by the Ministry of Health in July this year. Over the recent years, the list of registered and allowed for import medications to treat hepatitis C has been expanded, the new clinical treatment protocol has been approved and a six-year target program to counteract viral hepatitis was adopted. Hepatitis is one of the leading causes of death among people living with HIV and higher-risk populations. Without a doubt, the discussion of availability of hepatitis diagnosis and treatment, introduction of treatment guidelines and implementation of the national viral hepatitis interventions will be an important part of the International AIDS Conference in Amsterdam in 2018. We discussed the reasons for the increased attention to the problem of hepatitis in KyrgyzstanIn with Nurgul Ibraeva, Chief Officer of the Department of Health Services and Medications Policy of the Kyrgyz Ministry of Health.

Statistics and the real picture

“The problem of viral hepatitis in Kyrgyzstan is growing every year. Blood-borne hepatitis B and C remain a challenging concern, as patients consult the doctors whey they already have advanced illness and complications, such as liver cirrhosis and cancer. During the Hepatitis Prevention Month, we raised awareness in the population about the need to get tested and offered discounted tests that were supported by private laboratories. Many people in Kyrgyzstan find the price for hepatitis testing (around $50) challenging, so patients often discover their disease at an advanced stage,” Nurgul Ibraeva says. “Following the official statistics, in the last five years 11,000–22,000 people with viral hepatitis were registered on an annual basis. Health services provide treatment to more than 2,000 patients with parenteral hepatitis (hepatitis B, C and D – author’s note), but we believe that the actual number of those infected is much higher: more than 250,000 people.”

Prevalence of hepatitis A is the highest. It accounts for 96% of the registered cases, with blood-borne hepatitis B coming second. According to the National Immunization Schedule, since 2000, hepatitis B vaccine is administered to all newborns free-of-charge. As a result, hepatitis B incidence had a fourfold decrease over the last 16 years. Currently, our health services register around 300–400 new cases of hepatitis B among adults annually, while incidence among children dropped to several isolated cases.

“Immunization brings its fruit. According to the Ministry of Health regulation, health workers exposed to blood should be vaccinated, yet no funds are allocated for it, and not every health worker can afford a vaccine,” Nurgul Ibraeva is saying. “Unfortunately, there is no vaccine against hepatitis C. Even if you use means of protection and take the necessary precautions, there is always a risk. Some health care staff remain untested, and it is our estimate that around 1000 health workers have hepatitis C.”

According to the Republican AIDS Center and the Research and Production Association “Preventive medicine” of the Kyrgyz Ministry of Health, in 2014–2015, the share of health personnel with hepatitis C in the general HCV prevalence amounted to 2.5%. The same percentage is attributed to the general public.

Hepatitis C prevalence is the highest among people who inject drugs (PWID). In 2010, 50% of all hepatitis C cases was registered among PWID. By 2015, this share dropped to 35%. Inmates are also among those especially vulnerable to hepatitis C. Over the last six years, 24–53% of all cases were identified in correctional institutions.

“Needle exchange services and opioid substitution therapy are available in Kyrgyzstan, including prisons,” Nurgul Ibraeva is telling. “Prevention programs strive to break the chain of transmission, but the share of infections remains high, even though we managed to stabilize the situation.”

As is the case with other population groups, key populations are still inadequately covered by diagnostic services. According to the official data, from 100 to 200 new cases of hepatitis C are annually registered in Kyrgyzstan. However, the estimated number of people with hepatitis C is much higher: 101,960 cases among the general population and more than 11,000 cases among people who use injecting drugs.

Availability of treatment

In April 2014, the coalition of non-governmental organizations under the initiative of the “Partner Network” Association of Harm Reduction Programs successfully lobbied changes in the Kyrgyz patent legislation. This allowed Kyrgyzstan to import and license generic medications to treat hepatitis C. Currently, a 12-week treatment course on the basis of an officially registered drug costs $615 for a generic and $1500 for the original.

“We have access to several licensed medications produced in China, Egypt and India,” Nurgul Ibraeva says. “If earlier treatment for one patient amounted to $15 000–20 000, today patients can choose medications they can afford. With the expansion of the list of available drugs, producers have been lowering their prices. Yet, patients still have to pay for treatment, which is a challenge for key populations.”

All imported medications have been included in the Essential Medicines List, which is a pre-requisite for the potential state procurement in the future. A Target Program to Address Viral Hepatitis for the period till 2022 has been approved, yet it does not guarantee treatment and does not have financial backing for the planned activities. At the same time, only among people living with HIV, the prevalence of parenteral viral hepatitis exceeds 14%. Over the past six years, the registered number of people with HIV and hepatitis C co-infection increased twofold and reached 701 cases in 2015. Advocates succeeded to include annual hepatitis C treatment for 100 people with HIV into the State Program for HIV Control. Treatment will be financed by the government for the period of five years. Besides, this year a Clinical Protocol for Diagnosis, Treatment and Prevention of Viral Hepatitis B, C and D has been approved. The document is aligned with the latest WHO recommendations and treatment regimens based on direct acting antiviral drugs that are widely available on the market.

The Need for a European Union Communication and Action Plan for HIV, TB and Viral Hepatitis

Author: Anke van Dam, AFEW International

For a couple of years, European civil society organisations advocate for a new European Communication and Action Plan for HIV. In the World Health Organisation, new HIV diagnosed infections in European region increased by 76%. These infections more than doubled in Eastern Europe and Central Asia (EECA) from 2005 to 2014. The whole European region accounted for 153 000 reported new infections in 2015 (ECDC 2017). The cumulative number of diagnosed infections in the European region increased to 2,003,674, which includes 992,297 cases reported to the joint ECDC/WHO surveillance database and 1,011,377 infections diagnosed in Russia, as reported by the Russian Federal AIDS Center.

Co-infection in the EECA region

According to ECDC monitoring and the WHO Europe HIV action plan  adopted in September 2016, these underline the high rate of tuberculosis (TB) and hepatitis B and C coinfection among people who live with HIV (PLHIV). In 2014, TB was the most common AIDS-defining illness in the eastern part of the region.

Of the estimated 2.3 million PLHIV who are co-infected with hepatitis C virus globally, 27% are living in the EECA region. An estimated 83% of HIV-positive people who inject drugs live with hepatitis C in the eastern part of the region.

Plan was prolonged

The European Union had a Communication ‘Combating HIV/AIDS in the European Union and neighbouring countries, 2009–2013’ and its associated Action Plan.

The overarching objectives of the Communication were to reduce the number of new HIV infections in all European countries by 2013, to improve access to prevention, treatment, care and support, and to improve the quality of life of people living with, affected by, or most vulnerable to HIV/AIDS in the EU and neighbouring countries. This Plan has been prolonged for another three years. It was followed up with a Commission Staff Working Document: ‘Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016.’’

Already during the period of the prolongation and for three years, the European civil society organisations, including AFEW International, that work in the field of HIV, are advocating for the new communication and action plan. So far without success, despite the fact that according to the evaluation, the Communication and its Action Plan were seen by stakeholders to have provided the necessary stimulus, continuous pressure and leverage for various stakeholders to advocate for and take actions against HIV/AIDS in Europe.

Response is developed

The epidemiology of the three diseases – HIV, TB and viral hepatitis – urged the European Commission to develop a ‘Response to the Communicable Diseases of HIV, Tuberculosis and Hepatitis C’ in 2016. Next to this, the European Commission changed the civil society forum on HIV and AIDS, an advisory body to the European Commission into a civil society forum on HIV, TB and viral hepatitis in 2017, in which AFEW International takes part. This combined focus from the European Commission and civil society organisations could give an impulse to meet the needs for prevention, treatment and care for the three diseases.

Actions within the plan

The European civil society organisations developed a list of actions that should be included in the new communication and action plan.

Prevention needs to be scaled up: HIV can be prevented by a combination of proven public health measures. Yet two third of the European countries do not have a prevention package at scale. Pre-exposure prophylaxis (PrEP) is only provided in a couple of countries.

Treatment access needs to be scaled up: treatment and early treatment improves the health outcomes of the patient and prevents onward transmission. Therefore, countries should scale up testing and offer treatment upon diagnosis and remove barriers to testing and linkage to care. Governments should remove political, legal and regulatory barriers preventing communities most affected by HIV (people living with HIV, gay men and other men having sex with men, migrants, people using drugs, sex workers, transgender person, people in detention) to access health services.

Medicines should be affordable: the price of medicines is still a major barrier to the implementation of treatment guidelines and combination preventions strategies including pre-exposure prophylaxis (PrEP).

Community-based services as one of the components of the health system: include and recognise community base services who can deliver services closer to affected populations as important part of the health system. Invest in them.

AFEW advocates for the plan

In July 2017 the European Parliament adopted the resolution on the EU’s response to HIV, tuberculosis and viral hepatitis. This is an important step towards a communication and action plan. The EU commissioner for Health and Food Safety Mr. Andriukaitis expressed that he is in favour, and a couple of governments also feel a need for such plan. The European Commission and the Commission on Public Health Directorate are still silent though.

AFEW International, together with many governmental and non-governmental organisations, think that the International AIDS Conference in Amsterdam in July 2018 would be a wonderful opportunity and the right moment for the European Commission to present its intentions and good will to fight HIV, TB and viral hepatitis by a communication and action plan. Civil society will not stop to advocate for this. Otherwise we feel that European citizens will be left behind.

AFEW Supports International Viral Hepatitis Elimination Meeting

The International Viral Hepatitis Elimination Meeting (IVHEM) will take place in Amsterdam on the 17-18th November 2017. The registration for the meeting is already opened and the program is announced. Since many AFEW International’s strategical activities are aimed at eliminating viral hepatitis in Eastern Europe and Central Asia (EECA), AFEW is glad to share the information about this event.

IVHEM is a global forum for the exchange of practical experiences for translating diagnostic and therapy advances of viral hepatitis into broad applications that accelerate progress toward elimination of viral hepatitis as a public health threat by 2030. Community organisations, researchers, public health practitioners and clinicians will come to Amsterdam for the meeting. The program includes practical examples of innovative intervention studies, country elimination programs and novel funding mechanisms testing and treatment, all focusing on meeting the 2030 targets.

With prevalence as high at 80-90%, Eastern Europe and Central Asia has some of the highest rates of hepatitis C among people who inject drugs in the world. AFEW has a broad approach towards groups in society that are at risk for HIV, TB and viral hepatitis and who have limited access to health services in the EECA region. Challenges in the region remain the same for many decades: instance repressive drug policies; stigma and discrimination of injecting drug users, people who live with HIV, sex workers and inmates; poor access to prevention and treatment of HIV, TB and viral hepatitis; inadequate coverage of treatment and affordable medicaments. Besides, international donor funding for harm reduction programs is decreasing.

You can find the flyer about the International Viral Hepatitis Elimination Meeting here. You can register for the meeting here, and find a program here.

EECA Organisations Supported Michel Kazatchkine

Michel Kazatchkine, United Nations Secretary-General’s Special Envoy for AIDS in Eastern Europe and Central Asia

AFEW International has reached out to organizations and networks in Eastern Europe and Central Asia with the request to sign the support letter for re-appointment of Michel Kazatchkine as United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.

His contract/mandate as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia ends on 30 June. His role in addressing three epidemics in the region (HIV/AIDS, tuberculosis, hepatitis) and to raise awareness at political and scientific level of the concerns regarding HIV, TB and viral hepatitis in the EECA region is crucial and very important, especially now as we have the opportunity to highlight the challenges and successes of the region at AIDS2018 Conference. Therefore, there is a dire need for a continuation of his support.

The letter, signed by more than 70 signatories has been sent to United Nations Secretary General António Guterres. You can read the letter here.

Call for Abstracts: Hepatitis-C Community Summit in Amsterdam

hep-c

AFEW International is glad to announce the call for abstracts for Hepatitis-C Community Summit that will take place in Amsterdam in April of 2017.

With the new medicines now available an opportunity exists to completely eradicate hepatitis C.  However,  a crucial factor for success will be the involvement of people living with hepatitis C. Also it will require pharmaceutical companies, governments, doctors, and health purchasers to come together to ensure these medicines are quickly available to all.

Please submit your abstract about innovative approaches, community initiatives, successful advocacy examples, successful ‘from research to practice’ examples before the 19th of February. You will be informed about acceptance at the end of February.

The meeting takes place in the heart of Amsterdam. A number of well known speakers already confirmed their participation.
You can find more information at www.hepatitiscommunitysummit.eu

The team of supporting organisations:

Correlation Network Hepatitis C Initiative

European Aids Treatment Group (EATG)

European African Treatment Advocates Network (EATAN)

European Network of People Who Use Drugs (EuroNPUD)

European Lever Patient Association (ELPA)

International Doctors for Healthier Drug Policy (IDHDP)

Aids Foundation East West

Alliance for Public Health, Ukraine

Fixpunkt, Germany

Hepatitis Info, Nederland

Prometheus Foundation, Greece

Compass Centre in Kharkiv, Ukraine: when Policeman Becomes an Uncle

img_0039“I come here often,” Senior Inspector of the Juvenile Prevention Department of National Police of Kharkiv region, Ukraine, Andrii Stadnik is sitting by the table in the centre Compass of Kharkiv City Charitable Foundation Blago. He is smiling and pointing at the table. “Look, here I even have my own cup to drink from…”

Andrii Stadnik started to work in police in 1998. He says he is very happy with his job now. In Compass he meets many children who are grateful for not being send to prison, and he likes to be able to help them. The regulars of the centre even call him uncle Andrii, and this shows very good relations between people in the Ukrainian culture.

18 years old Oleksandr (Sasha) is sitting in front of Andrii, at the same table. Sasha is one of the main characters in the film that was made about the centre Compass a few years ago. Once he was detained by Andrii Stadnik and stayed under police control for some time. Now, after the client management program at Compass, Olexandr is doing much better. He even found a job as a security guard. “Now I somehow feel as Andrii’s colleague,” Sasha smiles.

“The criminal juvenile cases decreased tremendously last years, due to the approach when juvenile police is collaborating with a youth centre that offers client management. These alternative supporting ways are more constructive and more effective,” Senior Inspector of the Juvenile Prevention Department is telling us. “Previously there were 2000 cases per year, and now it is 362. The formulas of substances that circulate on the streets change so fast that young people can often not be prosecuted, but by giving youth an option and an alternative for other options, young people have less problems and also cause less problems for the society they live in.”

img_0036There are 492.000 children in the region in total. 897 families are under juvenile department control in Kharkiv region in Ukraine. The Juvenile Police checks these families, sees how they are doing, and if there are cases of child abuse, financial problems, and so on. Kharkiv Juvenile police is also inviting colleagues from other smaller cities or villages, and teaches them how to work with the Centre Compass. Through this cooperation they found out that young people from the region have difficulties with coming to the Centre since Kharkiv is too far for them. That is why now once a week a social worker of the Centre travels to the villages to counsel young people in need there.

Kharkiv City Charitable Foundation Blago has a long history of working with key populations, including people who use drugs, sex workers, men having sex with men and street children. The organisation started to work with adolescents using drugs since 2012 within the framework of “Bridging the Gaps: Health and Rights of Key Populations” project, through ICF “AIDS Foundation East-West” (AFEW-Ukraine.) Bridging the Gaps project supported the opening of the centre Compass that specifically serves vulnerable adolescents and young people, focusing on youth using drugs. The centre offers psychological counseling services, medical help, testing for HIV, hepatitis B and C. It is a daycare facility with social workers, psychologists and medical workers. The centre is providing case management services to youth using drugs, and also works with youth in prisons, and vocational schools.

Today We Celebrate 15 Years of AFEW!

15yearsafew_logo_proposal2Dear AFEW supporters and partners!

Today is a very important day for AFEW International. We are honouring World AIDS Day 2016, and also celebrating the 15th anniversary of our organisation. We are very grateful that we have spent these wonderful 15 years with your support and appreciation, and we would like to thank you for this!

We know that 15 years of our work would be not possible without you. We understand that together with you we are working towards a healthy future of our region. We realize the potential and current issues of Eastern Europe and Central Asia, and we are confident that we will be able to overcome them together with you. Thank you for being with us throughout our successes and challenges!

Having a leading position with expertise in HIV, TB and other related public health concerns in Eastern Europe and Central-Asia, AFEW will continue fighting stigma and discrimination, upholding the human rights, and improving the access to and quality of health services for key populations at risk for HIV, TB and viral hepatitis. This is still so much needed as the region where we work is still experiencing HIV growth, faces increased incidence of MDR-TB and has a high prevalence of Hepatitis C. Our activities help to change the future of the region and contribute to a healthy and comfortable life of people!

Thank you for being with us!

Happy World AIDS day and happy AFEW anniversary!

Sincerely,

AFEW International

HIV-Hepatitis Testing Week 2016 is Held in 50 Countries

525x2957rkvetk3ucpjk82HIV-Hepatitis Testing Week will take place from 18-25 November 2016 in 50 European countries. Testing week is an initiative that was launched in Europe in 2013 to help more people to become aware of their HIV status. Now in its fourth year and the second time hepatitis testing has been included.

Today, at least one in three of the 2.5 million people living with HIV in Europe are unaware that they are HIV positive. Half of those living with HIV are diagnosed late – which delays access to treatment.

Hepatitis B and C are common among people at risk of and living with HIV. Around 13.3 million people and 15 million people are living with hepatitis B and C in the WHO European Region, respectively. As the disease is often asymptomatic and left untreated, chronic hepatitis is a major cause of liver cirrhosis and live cancer. The majority of people with hepatitis C remain undiagnosed and only a small minority in Europe (3.5%) receive treatment.

These statistics suggest that we need to be doing more to encourage individuals who are unknowingly living with HIV and/ or hepatitis to take a test, and to better target people who could be at risk.

European HIV-Hepatitis Testing Week offers partners across Europe the opportunity to unite to increase awareness of the benefits of HIV and hepatitis testing among those who are at risk. In 2015, more than 400 organisations from across 53 countries took part in testing week and thousands more people are now aware of their HIV and hepatitis status.

You can read more information about the testing week here.

Organizations can sign up to participate here.

European Hepatitis Awareness Week is Celebrated for the First Time

1329521660_500x506Today, only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated. This year AFEW is joining the celebration of the First European Hepatitis Awareness Week on 25 – 29 July, the week of World Hepatitis Day, falling on 28 July.

A staggering 95% of people infected with hepatitis B or C around the world do not know they are infected. One reason for this is that people can live without symptoms for many years. When they find out they have hepatitis, it is often too late for treatment to be fully effective. As a result, liver damage becomes cirrhosis or liver cancer.

By 2020 the World Health Organization would like to see five million people receiving treatment for chronic hepatitis B virus infection, three million people having been treated for chronic hepatitis C virus infection and the number of new cases of chronic hepatitis infection reduced by 30% compared with the number of new cases in 2015. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures.

The Hepatitis B and C Public Policy Association encourages you to sign the petition and to ask European and national policy-makers to officially adopt the “European Hepatitis Awareness Week” which would become an occasion to hold intensive, coordinated awareness-raising and educational activities across Europe.