1. Achieving WHO Recommendations for HCV Elimination in the Eastern Mediterranean Region
I. Waked
April 12, 2016

2. WHO Eastern Mediterranean Region
Population: ~600 Million
Afghanistan
Oman
Bahrain
Pakistan
Djibouti
Palestine
Egypt
Qatar
Iran
Saudi Arabia
Iraq
Somalia
Jordan
Sudan
Kuwait
Syria
Lebanon
Tunisia
Libya
UA Emirates
Morocco
Yemen
Occupied Palestinian Territory

3. In 2016, there are approximately 15
In 2016, there are approximately 15.2 million viremic HCV infections in the Eastern Mediterranean region (2.4% prevalence)
Prevalence
(Viremic)
Total Infected
250,000
6,000,000
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-12.0%
25,000
Source: Polaris Observatory (

4. In 2016, there are 15. 2M viremic infections, 2
In 2016, there are 15.2M viremic infections, 2.9M already diagnosed, 1.7M previously treated and 990K cured in the region
Median Age: yrs
20%
The viremic prevalence of HCV in the Eastern Mediterranean region is 2.4% with nearly one fifth of infections already diagnosed.
In 2016, an estimated 1.7M patients (or 11% of total infected) are treated.
Source: Polaris Observatory (

5. There is a wide range of prevalence, diagnosis and treatment rates across the Eastern Mediterranean region
Bubble Diameter: HCV Prevalence 4% 2% 1%
Source: Polaris Observatory (

6. Two countries account for >80% of viremic HCV infections and treated patients
80% of Total
Viremic HCV Infections (2015)
80% of Total
Number Treated & Treatment Rate
(Treatment Rate)
Source: Polaris Observatory (

7. The number of treated patients increased in 2015 after a period of warehousing patients
Total Number Treated in Eastern Mediterranean Region
Source: Polaris Observatory (

8. Base 2014 Scenario – For comparison, the treatment paradigm in 2014 was extrapolated into the future
Continue to treat with Peg IFN based therapies
Most treatment is provided to patients with a fibrosis stage of ≥F1
Screening is continued each year to find new HCV cases
2014
2016
2017
2019
2021
2025
Treated
152,500
Newly Diagnosed
326,900
Fibrosis Stage
≥F1
New Infections
414,900
Treated Age
15-64
SVR
58%
Source: Polaris Observatory (

9. HCV infections will decline by 5%, while liver related deaths (LRD), HCC & decompensated cirrhosis (DC) will increase by 30-35%

10. Current 2015 Scenario – Extrapolate future treatment paradigm based on the current (2015) practice
Switch to direct acting antivirals with higher SVR
Keep the number of treated constant after 2015
Most treatment is provided to patients with a fibrosis stage of ≥F1
2014
2015
2016
2018
2020
2025
Treated
152,500
322,000
Newly Diagnosed
326,900
Fibrosis Stage
≥F1
New Infections
414,900
Treated Age
15-64
SVR
58%
86%

11. HCV infections will decline by 15%, while liver related deaths (LRD), HCC & decompensated cirrhosis (DC) will increase by 35% by 2030

12. After 2032, fewer than 145,000 individuals need to be treated annually
WHO Scenario – Increase screening, treatment and eligibility to achieve a 90% reduction in new infections and a 65% reduction in LRD
Switch to direct acting antivirals with higher SVR
Increase treatment to achieve a >65% reduction in liver related deaths and a 90% reduction in new infections
Expand screening to find infected individuals to treat
Expand treatment to all patients (>=F0)
Starting in 2017, expand treatment to up to 69 years of age
2014
2015
2017
2019
2021
2025
Treated
152,500
310,000
465,300
562,600
928,600
Newly Diagnosed
326,900
523,100
784,600
941,00
941,500
Fibrosis Stage
≥F1
≥F0
New Infections
414,900
311,200
186,700
93,400
37,300
Treated Age
15-64
15-69
SVR
58%
86%
90%
95%
After 2032, fewer than 145,000 individuals need to be treated annually

13. Start to run out of patients to treat
HCV infections will decline 80% by 2030 and 95% by 2035, while LRD will decline 65% by 2030 and 90% by 2035
Start to run out of patients to treat

14. The 2016 prevalence is estimated to be 2%
In 2016, there are an estimated 15 million HBsAg+ individuals in the Eastern Mediterranean region with data for 82% of the infected population
HBsAg+
(Prevalence)
<1.0%
1.0%-2.5%
2.5%-5.0%
5.0%-10.0%
>10%
Total Infected
200,000
1,000,000
4,000,000
The 2016 prevalence is estimated to be 2%
Source: Polaris Observatory (

15. Eight countries accounted for 80% of all hepatitis B infections in the Eastern Mediterranean region
HBsAg+ Individuals (2016)
80% of Total
73% % of infants receiving 3 doses of HBV vaccine (2014)
94%
88%
75%
99%
94%
62%
99%
Source: Polaris Observatory (

16. In 2016, it is estimated that 12% of HBsAg+ individuals in the Eastern Mediterranean region are HBeAg+
HBeAg+ Prevalence
(% of HBsAg+)
<2.5%
2.5%-5.0%
5.0%-10.0%
10.0%-20.0%
>20%
Source: Polaris Observatory (

17. In 2016, it is estimated that 16% of HBsAg+ individuals in the region are anti-HDV+
Anti-HDV+ Prevalence
(% of HBsAg+)
<2.5%
2.5%-5.0%
5.0%-10.0%
10.0%-20.0%
>20%
Source: Polaris Observatory (

18. Pakistan and Egypt account for >80% of HCV infections in the region
Conclusions:
There are an estimated 15.2 million viremic HCV and 14.8 million HBV infections in the region
Pakistan and Egypt account for >80% of HCV infections in the region
Eight countries in the region account for 80% of HBV infections with Pakistan and Sudan leading
It is feasible to eliminate HCV infections in the Eastern Mediterranean region region
Programs to reduce new infections are critical to achieve elimination in the region - awareness campaigns, education of medical students/ community, adoption of single-use syringes, and programs for high risk populations (super injectors, dialysis patients, etc)
Treatment has to be increased to 6-10% of total infections (coupled with active screening)
Screening will become necessary as early as 2017 to ensure there are enough patients available for treatment