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.

Hepatitis C-free Europe is possible by 2030

BRUSSELS, 17 February 2016 – Europe’s leading experts, medical specialists and patient advocacy groups on hepatitis announced their intention to work towards the elimination of Hepatitis C Virus (HCV) in Europe by 2030.

The ‘Hepatitis C Elimination Manifesto’ was presented at the first EU HCV Policy Summit, organised by the Hepatitis B and C Public Policy Association, and supported by the main European patient and clinician groups.

Signatories of the ‘Hepatitis C Elimination Manifesto’ pledge to:

− Make hepatitis C and its elimination in Europe an explicit public health priority to be pursued at all levels
− Ensure that patients, civil society groups and other relevant stakeholders are directly involved in developing and implementing hepatitis C elimination strategies
− Pay particular attention to the links between hepatitis C and social marginalisation
− Introduce a European Hepatitis Awareness Week

Vytenis Andriukaitis, Commissioner for Health and Food Safety, delivered a keynote speech at the event, commenting: “Hepatitis C has in the past been referred to as a “silent” epidemic within the European Union. It is high time that we brought this “silent” epidemic out of the shadows and into the light, so I welcome initiatives such as this Summit and the Elimination Manifesto to create momentum for action, for raising awareness and for stimulating discussion”.

After twenty five years of research, scientists have delivered the means to effectively cure hepatitis C, paving the way for elimination in Europe within the next decade. “What would have taken a hundred years for us to achieve, is now at hand! This is a unique opportunity, but political action is needed to make this happen”, stated Prof Angelos Hatzakis, Co-Chair of the Hepatitis B and C Public Policy Association. “Our ‘Elimination Manifesto’ is a rallying platform for policymakers and advocates. If we act now, Europe will be hepatitis C free by 2030”, continued Prof Hatzakis. The specific challenges of hepatitis C require holistic, people-centred, health system-wide approaches to disease awareness, prevention and integrated care, with all stakeholders combining their diverse skills and resources in a unified response.

“Succeeding against hepatitis C in Europe is even more important given the current international crises and refugee flows towards our countries”, explained Cristian-Silviu Buşoi, Member of the
European Parliament and Co-chair of the Parliament’s Friends of the Liver group. Buşoi continued: “Elimination strategies need to take into consideration the links between hepatitis C and marginalised groups, such as recent migrants, people who inject drugs and others.”

“The Manifesto sets out our vision and commitment to eliminate hepatitis C in Europe”, declared Prof Michael P. Manns, Co-Chair of the Hepatitis B and C Public Policy Association, “concrete actions at all levels must follow to achieve our goal”. The Manifesto will be presented to national and local governments as well as to the European institutions to encourage action.

Signatories

The Elimination Manifesto is supported by the following organisations:

  1. European Liver Patients Association (ELPA)
  2. European Association for the Study of the Liver (EASL)
  3. Viral Hepatitis Prevention Board (VHPB)
  4. The Correlation Network
  5. The International Center for Migration Health and Development (ICMHD)
  6. The World Hepatitis Alliance (WHA)
  7. Hepatitis B and C Public Policy Association

About Hepatitis C in Europe

  • Hepatitis C (HCV) is a major public health problem in Europe. In the EU more people die each year from HCV than from HIV.
  • HCV is 7 times more prevalent than HIV in Europe.
  • An estimated 15 million Europeans are chronically infected, including 5.5 million living in EU; each year there are 27,000-29,000 newly diagnosed HCV cases in the EU/EEA.
  • Existing evidence shows that, for some European countries, annual deaths from HCV have quadrupled over the past 20 years.
  • Even with Europe’s generally good tracking of epidemics, HCV continues to spread undetected as a “silent pandemic” as patients often have no symptoms during the first 20-30 years.
  • HCV is the leading cause of liver transplantation in adults; healthcare costs increase exponentially with the progression of liver disease, which goes in parallel with patients’ suffering.
  • In addition, indirect costs related to loss of productivity make the economic burden of the disease even more significant.

About Elimination

  • Elimination of a disease is intended as the reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts.
  • HCV elimination was made possible by recent therapeutic advances, which have made HCV curable in the majority of instances – cure rates have progressed from 6% in 1991 (first interferon approved treatment for HCV) to over 90% in 2014 (directly acting antivirals introduced).
  • Holistic approaches and strategies to improve overall awareness, increase testing for those at risk and link infected individuals to specific care pathways need to be developed.

About the “Hepatitis C Elimination Manifesto”

The main authors of the “Hepatitis C Elimination Manifesto” are:

  • Prof Jeffrey V. Lazarus, University of Copenhagen (Denmark) – Board Chair of AIDS Foundation East-West (AFEW)
  • Prof Mark Thursz, Imperial College, London (UK)
  • Prof Pierre Van Damme, Viral Hepatitis Prevention Board, Vaccine and Infectious Disease Institute, Antwerp (Belgium)
  • Prof Angelos Hatzakis, Athens University Medical School (Greece)

About the first EU HCV Summit

The EU HCV Summit was organised by the Hepatitis B & C Public Policy Association in partnership with European Association for the Study of the Liver (EASL), the Eurpean Liver Patient Association (ELPA) and the Correlation Network. It was financially supported by AbbVie, BMS, Gilead and MSD. The Summit, which was attended by 120 policymakers and stakeholders from across Europe and beyond, was officially endorsed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the International Centre for Migration, Health and Development (ICMHD), the European Parliament Friends of the Liver Group and the World Hepatitis Alliance (WHA).

-ENDS-

For more information, please contact:
Ann Fox, Hepatitis B & C Public Policy Association afox@hepbcppa.org
19 rue Eugène Ruppert
L-2453 Luxembourg
Tel: 0039 339 65 96 105

Contest Seeks Innovation in Hepatitis Testing

Has your group found a new way to promote Hepatitis B or C testing, reaching completely new populations in new places, or using new methods? If so, Social Entrepreneurship for Sexual Health (SESH Global) in collaboration with the WHO Global Hepatitis Programme is organizing an innovation contest on hepatitis B and C testing.

The purpose of this contest is to identify innovative examples of delivering hepatitis B and C testing that will be highlighted within the 2016 WHO Hepatitis Testing Guidelines.

The innovation could be delivery to a new population, in a new setting (eg. prisons), or a new messaging approach to encourage testing uptake (eg. social media). The goal is to identify interventions aimed to increase testing, providing real-world examples to be used alongside the WHO Hepatitis Testing guidelines.

Your submission, in the form of a 300-500 words description of your innovation and its impact, must be submitted by March 1, 2016. Submissions in English are encouraged, however we will accept entries in Arabic, Chinese, French, Russian, and Spanish. Send your creative contribution!

 #HepTestContest