Prevalence of hepatitis B and C markers in a population of an urban university in Rio de Janeiro, Brazil: a cross-sectional study

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach

Introduction and aim

Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO).

Methods

A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024.

Results

An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025–2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality.

Conclusion

Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers.

Age-standardized mortality rates related to viral hepatitis in Brazil

Background

Liver-related mortality has been increasing worldwide. We aimed to estimate the age-standardized mortality rates from viral hepatitis in Brazil.

Methods

The Brazilian National Death Registry was analyzed from 2008 to 2014. Viral hepatitis deaths were defined by the following ICD-10 codes in the death certificate: hepatitis A [B15.0; B15.9]; hepatitis B [B16.2; B16.9; B18.1]; hepatitis C [B17.1; B18.2]; hepatitis Delta [B16.0; B16.1; B18.0; B17.0] and other viral hepatitis [B17.2; B17.8; B18.8; B18.9; B19.0; B19.9]. Crude mortality rates were calculated by the ratio between total number of deaths and estimated population. Mortality rates were age-standardized by the direct method using the WHO standard population.

Results

Thirty four thousand ,nine hundred seventy eight deaths had viral hepatitis mentioned in their death certificate [65% male, aged 58 years, 73% associated with hepatitis C]. Age-standardized mortality rate (95% CI) due to viral hepatitis was 2.695 (2.667–2.724) deaths per 100,000 inhabitants: South region had the higher rates [3.997 (3.911–4.085)]. Mortality rates associated with hepatitis A and Delta were 0.032 (0.029–0.035) and 0.028 (0.025–0.031), respectively. Hepatitis C mortality rates were 4-fold higher than those associated with hepatitis B [1.964 (1.940–1.989) vs 0.500 (0.488–0.512)]. South region had the higher rates for hepatitis C [3.163 (3.087–3.241)] and North had the higher rates for hepatitis A [0.066 (0.049–0.087)], B [0.986 (0.918–1.058)] and Delta [0.220 (0.190–0.253)].

Conclusion

Viral hepatitis remains a major public health issue in Brazil. Mortality rates were not homogeneous across the country, suggesting that health policies should be customized according to geographical location.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-017-2619-y) contains supplementary material, which is available to authorized users.