How would China achieve WHO’s target of eliminating HCV by 2030?

ABSTRACT

Introduction: Hepatitis C virus (HCV) infection is a major global health concern on the rise, prompting unprecedented efforts by the World Health Organization (WHO) to eliminate this epidemic by 2030. Being the country with the largest HCV-infected population in the world, China has been faced with a general lack of awareness for HCV, low treatment uptake and subpar collaborations among healthcare providers and stakeholders.

Areas covered: This review discusses the epidemiological situations of HCV infection and the challenges in HCV management in China. This review also explores micro-elimination strategies in China, identifying potential sub-populations for concerted efforts in eliminating HCV. As DAAs are increasingly recognized as a more effective alternative to traditional regimens, the cost-effectiveness and budget impacts of bringing more DAAs into the reimbursement lists are also addressed. Several small-scale targeted literature searches were conducted in PubMed for various topics covered in the article, and hand searching was performed to fill any data gaps. More recent data were used wherever possible.

Expert opinion: Considering the unique socioeconomical landscape of China, micro-elimination strategies might be more effective and should be targeted at high-risk populations. Varying regional needs in HCV care across the country necessitate decentralized approaches in research and policy-making.

KEYWORDS:

• Direct-acting antiviral
• epidemiology
• hepatitis C
• micro-elimination

Article highlights

• China has a unique epidemiological profile of HCV, with varying prevalence across different regions and uneven genotypic distribution, all of which contributes to an immense disease burden.

• Challenges in HCV management in China include lack of general awareness, poor linkage to care and subpar accessibility and affordability of therapeutics. Recently, more direct-acting antivirals became available in China, which could potentially improve HCV patient outcomes.

• Micro-elimination strategies targeted at high-risk population would be more practical in the Chinese context. Regional differences should also be considered in policy-making and resource management.

Acknowledgments

The authors would like to thank Ma Qian and Amrita Viswambaram (employees of Costello Medical, Singapore, funded by Gilead Sciences, Shanghai, China), for writing assistance and editorial support for the development of the manuscript. The authors are entirely responsible for the scientific content of this paper.

Declaration of interest

L Wei has consulted for Abbvie, Allegan, BMS, and Gilead, and received research funds from Abbvie, BMS and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A peer reviewer on this manuscript has disclosed that they have received speaker honoraria and research, project and travel grants from Abbvie, Gilead and/or MSD. Peer reviewers on this manuscript have received an honorarium for their review work but have no other relevant financial relationships apart from those disclosed.

Additional information

Funding

This paper was funded by research grants from Gilead Sciences under the Conquering Hepatitis C via Micro-Elimination (CHIME) program (Research ID: IN-CN-987-5457). All manuscript editorial and administrative support has been funded by Gilead Sciences.