National Viral Hepatitis Control Program SDG goal 3.3 to …bat viral hepatitis

1. National Viral Hepatitis Control Program • SDG goal 3.3 to ….combat viral hepatitis

2. Universal Health Coverage Umbrella for Viral Hepatitis- India’s response Swachh Bharat MCH Immunization NACP HCW Injection Safety Surveillance Across all geographies, all people ( focus on priority groups), finances under NHM ( domestic budget), Linkages to other programs and schemes ( NCD, Ayushman Bharat)

3. Ensuring Universal Health Coverage Ensuring Access Addressing Quality Ensuring Financing • All states and UTs • Identifying key Population- for different viruses • Addressing priority populations • Identifying appropriate intervention • Integrated approach • Avoiding duplication • Domestic funding for sustainability • Training and capacity building • Data quality • Quality services • Quality commodities

4. Five key documents

5. Aims • Elimination of Hepatitis C by 2030 • Reduction in the infected population, morbidity and mortality associated with Hepatitis B and C • Reduce the risk, morbidity and mortality due to Hepatitis A and E.

6. Key Objectives • Enhance community awareness on hepatitis and lay stress on preventive measures • Provide early diagnosis and management of viral hepatitis at all levels of healthcare • Develop capacities for implementation of standard diagnostic and treatment protocols

7. Key Objectives • Strengthen the existing infrastructure facilities • build capacities of existing human resource • raise additional human resources, only where required • Develop linkages with the existing programs/ ministerial activities • NACP, Immunisation, MH, Mo Drinking water and Sanitation • Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.

8. Overall Framework- Snapshot • Guideline and Policy Formulation • M & E, Surveillance, Research • Central Procurement • Coordination Annual PIP and targets, State level planning & scaleup, intersectoral coordination, M & E Diagnosis, Treatment, Referral, Quality Control • Key Documents: • National Action Plan- costed; Operational plan for roll out of NVHCP; National Laboratory Guidelines for Testing of Viral Hepatitis; National Guidelines for Diagnosis and management of Viral hepatitis; Technical Guidelines for management of hepatitis B; National M & E framework and the electronic MIS

9. Key interventions-Prevention • Awareness generation & Behavior Change Communication • Immunization for hepatitis B – birth dose, high risk groups, health care workers • Provision of safe blood and blood products • Injection Safety by Use of RUP/AD syringes in all government HCFs • Safe socio-cultural practices

10. Key interventions-Diagnosis & Treatment • Screening - serological tests • Confirmation - molecular tests (where required) • Treatment of uncomplicated cases - at treatment centres, drug dispensation up to HWC • Treatment of complicated cases at model treatment centres • Referral and linkages • Capacity building and quality assurance

11. Model for Diagnosis

12. Model for Treatment Model Treatment centers for Treatment of Hepatitis B & C for complicated cases & management of other hepatitis; Phased scale up Treatment centers for Treatment of Hepatitis B & C; Refer complicated cases to Model Treatment Centers Dispensation

13. Key Enablers for NVHCP • Inter-sectoral coordination • Harnessing Existing Capacities • Central Procurement for Economies of Scale • Community Involvement • Technical Working Groups • Supply Chain Management • Online M & E System • Sustained Domestic Funding

14. Operationalizing the plan for testing and Treatment: the stepwise approach Inputs • Development of the National Action Plan- the guiding document • Financing the plan: 100% domestic budget, integrated planning • Constitution of Technical Resource Groups: Policy and guidelines development • Development of standard training manuals • Laboratory guidelines • Clinical Management guidelines The Process • Advocacy on World Hepatitis Day and other forums • Constitution of state steering committees • Inclusion of Viral hepatitis in State annual plans- integrated approach • Training of master trainers- over 435 across the country • Development of on line recording and reporting system • Procurement of test kits and distribution in the vast country

15. Operationalizing the plan for testing and Treatment: the stepwise approach Outcomes / Progress till date • 95 centers functional in 22 states • 20,000 approx. patients started treatment in short duration (Sept 2018 to Sept 2019) • Consolidated the smaller projects and state programs under the National program for harmonization • Introduction of Hepatitis B testing for pregnant women • Guidance on vaccination for health care workers at risk • Guidance to shift towards RUP in government sector in a phased manner • Targeted testing started: vulnerable population groups prioritized

16. Status update of State/UT

17. National Viral Hepatitis Control Program

18. National Viral Hepatitis Control Program

19. Thank You