Eliminating Hepatitis in the Andean Region: Supporting National Responses

Project overview

The purpose of this project was to raise the level of awareness of hepatitis and hepatitis elimination across Colombia, Ecuador and Peru. This was the first time such a significant hepatitis-specific project had been undertaken in the South American continent. 

Context

South America has a population of 422 million people and is comprised of 13 countries. Between 2016 and 2018, PAHO, together with the Ministries of Health, estimated there to be approximately two million people living with hepatitis B and two million people living with hepatitis C in South America. Approximately half of this burden is found in countries of the Andean sub-region: Bolivia, Colombia, Ecuador, Peru, Venezuela and Chile. While the impact of HBV immunisation has been strong, efforts beyond immunisation – diagnosis and treatment of HBV and HCV – remain insufficient to reach elimination. For example, in 2017, just 2,500 people in this region, around 0.3% of the total, were treated for HCV.

Outcomes

• The 2020 meeting of Regional Health Ministers of Andean countries (REMSAA) endorsed that hepatitis elimination is a public health problem.  
• The first national elimination plan for viral hepatitis in Peru, where hepatitis B is an important public health problem, was developed.   
• The Center for Disease Analysis Foundation developed investment cases for HBV and HCV in Ecuador and Peru. The investment cases have provided tools for Ministries of Health to plan their nations’ paths towards elimination, allowing countries to estimate the impact of actions, the cost of expanding them and their effectiveness in reducing acquisitions, cases of liver disease and deaths. These investment cases have become an important tool for technical authorities to advocate for expanding activities related to the prevention and management of hepatitis B and C.  
• Two assessments of the national health sector response to viral hepatitis were carried out in Colombia and Peru in late 2022.   
• This project had a strong equity and human rights component, benefitting vulnerable groups living in the Andean subregion, with special emphasis on primary care health personnel who provide primary care to migrants and vulnerable populations and populations with high rates of viral hepatitis. As a result, the Colombian authorities agreed to revise guidelines and simplify health services delivery to close access gaps, particularly for vulnerable populations. 
• Through the work on national plans and clinical guidelines in Colombia and Ecuador, the project promoted an approach to hepatitis B control beyond vaccination.  

Catalytic impact

Because of the success of the missions in Colombia and Peru, partners decided to carry out similar missions in Ecuador and Bolivia. PAHO and the Organismo Andino de Salud-Convenio Hipolito Unanue (ORAS–CONHU) will enhance their efforts to eliminate viral hepatitis in the Andean countries. ORAS-CONHU will now develop a plan for the elimination of viral hepatitis in the Andean region – the first such subregional initiative in the Western Hemisphere.