| The World Health Organization (WHO) has endorsed a global strategy to eliminate viral hepatitis by 2030. The strategy identifies key health interventions and service coverage targets that must be reached if countries are to meet the hepatitis B and C incidence and mortality targets. As of 2015, the coverage levels of these interventions vary from 97% for access to safe blood to <10% for access to hepatitis B and C testing and treatment services. The four key interventions that have the lowest levels of coverage as defined by WHO are: prevention of mother-to-child transmission (PMCT) of HBV, harm reduction among persons who inject drugs (PWID), and hepatitis testing and treatment. For PMCT, the top priority is to identify novel approaches to increase birth-dose coverage and to provide antivirals for pregnant women with high HBV viral load. For prevention among PWID, more information is needed on how to deliver harm reduction in the most effective way to maximize access and adherence and to integrate hepatitis testing and treatment in harm reduction sites. The efficacy of pre-exposure and post-exposure prophylaxis should also be assessed. The biggest challenge to meeting WHO’s hepatitis elimination targets relate to testing and treatment, where coverage is very low. Novel approaches are needed to identify ways to expand hepatitis testing to the general population as well as to specific high-risk groups. For treatment, novel service delivery models are needed to provide hepatitis treatment in primary-care settings by non-specialist cadres. One of the challenges to the scale-up of these interventions is that there is a general lack of knowledge as to how to best deliver them so that programs are effective and reach the largest number of persons. This gap, which is known as the research to implementation gap must be overcome by an increase in implementation science research, which is defined the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care. |
