Viral hepatitis control program

Viral Hepatitis Control Programme with Latest additions !!! This presentation has maximum latest additions from GoI programme guidelines . Original ppt has been modified according to local needs . Feel free to share and use with modifications if needed

1. N A TIONA L V I RAL HE P A TITIS C ONT R O L P R OGRAM D r. Rishabh Kumar Rana MBBS ,MD ,CCIP Assistant Professor SNMMCH 8/2/ 2 19 NV H C P 1

2. CONTENTS EPIDEMIOLOGY. INTRODUCTION TO THE PROGRAM. AIM & OBJECTIVES. PROGRAMME STRATEGIES. PROGRAMME COMPONENTS. IMPLEMENTATION STRUCTURE. PREVENTION OF VIRAL HEPATITIS. MONITORING, SURVEILLANCE, SUPERVISION AND EVALUATION. TOTAL NO SLIDES: 38 8/2/2019 N VH C P 2

3. Introduction Viral hepatitis is a global public health problem of epidemic proportions that caused 1.34 million deaths in 2015 a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. Infection can be caused by the five known hepatitis viruses – A, B, C, D and E (HAV, HBV, HCV, HDV and HEV). HEPATITIS B AND C are responsible for 96% of overall hepatitis mortality. 8/2/2019 N VH C P 3

4. National Viral Hepatitis Control Program (NVHCP) prevention and control of viral hepatitis- free of charge screening, diagnosis, treatment & counselling services to all, (specially to people belonging to high-risk groups).

5. E P I D E M I O L OGY 8 /2/ 2 19 N VH C P 4

6. G l o bal It is estimated that 325 million people worldwide are living with chronic HBV or HCV infection. Approximately, 1.75 million people were estimated to be newly infected with HCV in 2015, increasing the total number of people living with Hepatitis C to 71 million . Hepatitis A Virus (HAV) infections caused approximately 11,000 deaths in 2015. It is estimated that Hepatitis E caused 44,000 deaths in 2015. *Source: WHO Global Hepatitis Report. 2017. 8/2/2019 N VH C P 5

7. In d i a HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure. HEV accounts for 10-40% of acute hepatitis and 15-45% of acute liver failure. Hepatitis B surface Antigen (HBsAg) positivity in the general population ranges from 1.1% to 12.2%, with an average prevalence of 3-4% . Approximately 40 million people are chronically infected with Hepatitis B and 6-12 million people with Hepatitis C. Chronic HBV infection accounts for 40% of Hepato-cellular Carcinoma (HCC) and 20-30% cases of cirrhosis in India. Chronic HCV infection accounts for 12-32% of HCC and 12-20% of cirrhosis. 8/2/2019 N VH C P 6

8. INTRODUCTION TO THE PROGRAM India is committed to progressively move towards elimination of viral hepatitis B and C and control other virus induced hepatitis. This is in line with our global commitment towards achieving Sustainable development goal (SDG) goal 3; target 3.3 which aims to “BY 2030, END THE EPIDEMICS OF AIDS, TUBERCULOSIS, MALARIA AND NEGLECTED TROPICAL DISEASES AND COMBAT HEPATITIS, WATER BORNE DISEASES AND OTHER COMMUNICABLE DISEASES”. Government of India is a signatory to the resolution 69.22 endorsed in the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 at 69 th WHA towards ending viral hepatitis by 2030 . • 8/2/2019 N VH C P 7

9. Aim Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030. Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepatocellular carcinoma. Reduce the risk morbidity and mortality due to Hepatitis A and E. 8/2/2019 N VH C P 8

10. OBJECTIVES Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high- risk groups and in hotspots. Provide early diagnosis and management of viral hepatitis at all levels of healthcare. D e v elop s ta n d a r d d i a g n os t ic an d t r e a tm e nt p r o t o c ols f or management of viral hepatitis and its complications. 8/2/2019 N VH C P 9

11. Strengthen the existing infrastructure facilities, build capacities of existing human resource and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country. Develop linkages with the existing National programmes towards awareness, prevention, diagnosis and treatment for viral hepatitis. Develop a web-based “VIRAL HEPATITIS INFORMATION AND MANAGEMENT SYSTEM” to maintain a registry of persons affected with viral hepatitis and its sequelae. 8/2/2019 NVHCP 10

12. PROGRAMME STRATEGIES Preventive and promotive interventions with focus on awareness generation, safe injection and socio cultural practices, sanitation and hygiene, safe drinking water supply, infection control and immunization. Co-ordination and collaboration with different Ministries and departments, NACP for safety of blood and blood products and with IDSP and NACP for surveillance. Increasing access and promoting diagnosis and providing treatment support for patients of viral hepatitis. Building capacities at national, state, district and sub district levels up to PHC and Health and Wellness center in a phased manner. 8/2/2019 N VH C P 11

13. PROGRAMME COMPONENTS Preventive component. Diagnosis and Treatment. Monitoring and Evaluation, Surveillance and Research. Training and capacity Building. 8/2/2019 N VH C P 12

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16. IMPLEMENTATION STRUCTURE AT NATIONAL, S T A T E A N D D I S T RIC T L E V EL The program will have two key prongs: P r og r am man a g emen t. Service delivery component. 8/2/2019 N VH C P 15

17. 1.PROGRAM MANAGEMENT The initiative will be coordinated by the units at the centre and the states: National Viral Hepatitis management unit(NVHMU) State Viral Hepatitis management unit(SVHMU) District Viral Hepatitis management unit (DVHMU) 8/2/2019 N VH C P 16

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19. 2 . S E RV I C E D E L IV E RY Synergies with the existing programs and relevant ministries of Government of India. New Interventions- Diagnosis and Management of Viral Hepatitis with focus on treatment of Hepatitis B&C. 8/2/2019 N VH C P 18

20. PREVENTION OF VIRAL HEPATITIS 8 /2/ 2 19 N VH C P 19

21. 1. Universal Immunization Program Strengthen routine immunization services to achieve and sustain the desired coverage of the timely birth dose followed by three doses of hepatitis B vaccine. Coordinate with the Universal Immunization Programme for mandatory immunization of all healthcare workers. Schedule recommends hepatitis B birth dose to all infants within 24 hours, followed by three doses at 6, 10 and 14 weeks to complete the schedule . 8/2/2019 N VH C P 20

22. India’s target for Hepatitis B immunization S.No. Country Targets (to be provided by UIP) Baseline ( 20 16 - 17) 2019-20 1 Coverage of Birth Dose of Hepatitis B ( All deliveries) 60% 90% 2 Coverage with three doses of Hepatitis B vaccine in infants (B3). 75% 95% 3 Routine Hepatitis B vaccination among health-care workers N/A Will be made Available 8/2/2019 N VH C P 21

23. 2.National AIDS Control Program (NACP) T he NV H MU wil l c o o r din a t e w ith N A CP f or su r v e i l lan c e of hepatitis in key populations, establishing linkages. F o r t e sti n g an d ca r e f o r hep a titis C in f e c t e d PL HI V and vaccination of the vulnerable population. T he SV HM U wi ll c o o r din a te in a si mi lar ma n n e r with t h e st a te machinery for executing the same. 8/2/2019 NVHCP 22

24. 3.Safety of blood and blood products To review and strengthen national policies and practices on blood safety those promote rational use of blood and blood products, and move towards 100% VOLUNTARY BLOOD DONATION . Setting up a mechanism for follow up of individuals detected positive on screening, their counselling, confirmatory testing and linkages to care and support services for viral hepatitis. Strengthen systems for surveillance, hemo-vigilance and monitoring of the incidence and prevalence of viral hepatitis infections in blood donors, and monitor the risk of post-transfusion hepatitis. 8/2/2019 NVHCP 23

25. Establish mechanisms for counselling of HBsAg& anti-HCV reactive blood donors for referral and follow-up to confirm the presence of infection by confirmatory tests & provide treatment for Hepatitis B and C where necessary. Developing/updating training modules with SACS, State Blood Transfusion Council and blood cells on safety of blood and blood products with special focus on prevention of Viral Hepatitis through transfusion of blood and blood products and linkages for those screened positive. 8/2/2019 NVHCP 24

26. 4.Harm reduction in key populations Targeted Interventions in key population include female sex workers (FSW), men who have sex with men (MSM), transgender (TG)& people who inject drugs (PWID), while bridge populations include migrants & truckers. Provide a package of prevention services. Needle syringe exchange program and opioid substitution therapy are provided for prevention of HIV among PWID. 8/2/2019 NVHCP 25

27. 5.Injection safety and infection control By 2020, 100% of all injections are administered with safety engineered devices. NVHMU and SVHMU will integrate with the national and state regulatory bodies to strengthen the infection prevention and control practices in healthcare settings. Coordinate with the Pradhan Mantri National Dialysis Program for making special emphasis on the component of injection safety and infection control in their program module. Coordinate with the regulatory body towards effective roll-out of re-use prevention (RUP) syringes, addressing prescriber practices and community preference. Coordinate with the Ministry of Environment & Forestry and pollution control board for capacity building for effective implementation of the bio-medical waste management rules. 8/2/2019 NVHCP 26

28. 6.Integrated Disease Surveillance Programme The NVHMU, SVHMU and DVHMU will integrate with the IDSP. To provide technical support for outbreak investigation and reporting and monitoring of outbreaks of viral hepatitis, specially hepatitis A and E. Assisting in rapid response team activities during outbreaks. Ensure linkages with the laboratory and treatment facilities of those affected in the outbreak with the disease. To involve all structures up to PHC level. 8/2/2019 NVHCP 27

29. DIAGNOSIS AND MANAGEMENT OF VIRAL HEPATITIS Laboratory services: Laboratory services are necessary for screening, confirmation and monitoring the response and outcomes of treatment. Treatment services: Designated treatment sites that are located within an existing health facility, such as district hospitals and state medical colleges will utilize the current health care system. 8/2/2019 N VH C P 28

30. LABORATORIES SERVICES L a b o r a t o r y se r vices a r e n e c essa r y f or s c r e e ni n g, c o nfi r m a tion and monitoring the response and outcomes of treatment. T o f ac ilit a te t h e same, t h e p r o g r a m wil l st r e n g t h e n t h e st a t e , district, and sub district level laboratories in a phased manner . 8/2/2019 N VH C P 29

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32. TREATMENT SITES The services under the hepatitis treatment initiative will be delivered through the designated treatment sites that are located within an existing health facility, such as district hospitals and state medical colleges. Model Hepatitis Treatment centres (MTC) will act as places for referral and mentoring of the other treatment centres (TC). The Hepatitis Treatment centre can be located in the district hospital or co- located with the sentinel sites. The diagnosis and treatment centers will have the capacity to differentiate whether the patient has advanced liver disease or not. 8/2/2019 N VH C P 31

33. Level Screening Confirmation Treatment of un c o mp l icated cases Treatment of Co m plica t ed case Health and Wellness centers Introduced in phased manner PHC Yes CHC Yes Yes In phased manner after assessing capacity District Hospital Yes Yes Yes Medical Colleges and specialised centers ( MTC) Yes Yes Yes Yes 8/2/2019 N VH C P 32

34. TRA I NING Training and capacity building are crucial in delivery of quality health care. Develop standardized training manuals and online training modules for health care providers and undertake their capacity building using conventional and other platforms. To identify centers over 3 years who could take the task of mentoring the human resource from the centers that are linked to them. These centers could also support the program in undertaking research and secondary data analysis to inform policy. 8/2/2019 N VH C P 33

35. MONITORING, SURVEILLANCE, SUPERVISION AND EVALUATION Surveillance : Systematic collection, collation, analysis, and interpretation of output and outcome-specific data for the planning, implementation, evaluation, and improvement of programme. The objective is to develop and implement evidence-based effective interventions. Monitoring : Monitoring of programme of all interventions at all levels will be the key to ensure the quality of services in the stipulated timeframe, with active involvement of programme management structure. 8/2/2019 N VH C P 34

36. Evaluation : Impact evaluation of the programmatic component of the viral hepatitis provides important feedback to the programme. Efficient evaluation mechanism can potentially identify key gaps and guide the programme to improve overall performance in synergistic areas, including water and sanitation, safety of blood and blood products and injection safety etc. Data management : Computerized data management system under the ‘ ‘INTEGRATED INITIATIVE FOR PREVENTION AND CONTROL OF VIRAL HEPATITIS’’ would facilitate automated data transfer. 8/2/2019 N VH C P 35

37. RECORD KEEPING A technical group will advise on development of the flow charts and mechanisms to address the collection and flow of information from ground level to national level in pre designed formats. Monitoring of the progress for the existing components for Immunization, Blood Safety and Drinking Water and Sanitation shall be done through the existing program and their recording and reporting system. Proper recordkeeping of client results is vital for providing quality service, tackling the medico-legal issues, and operational research. A s pe r t h e gu id e l i ne s , a ll docu m en ts m u st b e sto r e d f o r a t le a st 5 years or as per state/ institutional guidelines whichever is longer. 8/2/2019 N VH C P 36

38. AWARENESS GENERATION In c r e a sing a w a r e n ess am o ng communication channels will general population. b e used ( l i k e mass V a r i o us me d i a , advertisements, radio jingles, posters, TV spots etc). Behavior change communication strategies for vulnerable groups. Continued focus on demand generation of services including hepatitis B birth dose and safe injections and testing for hepatitis. Increasing treatment literacy and adherence to treatment. 8/2/2019 N VH C P 37

39. District ROLES These laboratories would be co- located with the Treatment Centres at the district hospitals. The capacities of these labs will be strengthened in a phased manner. The state laboratories will train the district laboratories in carrying out serological testing for viral hepatitis (immuno-assays/rapid Tests). These laboratories will perform the testing and would be linked to other treatment centres in the district, sub-district levels in the region. Roles and Responsibilities Sample collection and serological testing under the NVHCP Molecular testing where feasible. Sample transportation for molecular testing, where necessary

40. THANKYOU 8 /2/ 2 19 N VH C P 38