Pakistan National Hepatitis Elimination Profile-FINAL
Pakistan National Hepatitis Elimination Profile-FINAL
Pakistan National Hepatitis Elimination Profile-FINAL
2.5% 4.3%
Prevalence of HBsAg, 2008 15 Prevalence Prevalence of chronic (viremic) HCV, 2020 21
Modelled estimate Modelled estimate
Prevalence of HBsAg, 2018, Punjab: 2.2% 19,20
Viremic HCV prevalence, 2018, Punjab : 4.8% 20
Prevalence of HBsAg, 2019, Sindh: 1.1% 19 Viremic HCV prevalence, 2020, Sindh: 3.8% 23
Survey/reported Viremic HCV prevalence, 2020, Balochistan: 3.1% 24
Viremic HCV prevalence, 2020, Khyber Pakhtunkhwa: 3.8% 21
Prevalence of anti-HCV, PWID: 62% 1
Survey/surveillance
9.8M
Number of persons living with HCV 21
2nd highest burden in the world
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
30,400 461,000
New HBV infections 18
New chronic HCV infections, 2019 21
Data from WHO Global Reporting Modelled estimate
Incidence Greatest risk factors for transmission include
blood transfusions (15%), history of hospitalization
(14%), dental treatment (13%), use of injections
(12%), and history of surgery (9%)
NO DATA
National prevalence of HBsAg declined
Percentage change in new
HBV infections, 2015-2020
from 2.5% in 2008 to 1.1% in Sindh in
2019 and 2.2% in Punjab in 2018, declines
WHO 2020 Target -30%
of 56% and 12% respectively. 15,19,20
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
Hepatitis B vaccination
50% coverage for newborns, 2016 7
WHO 2020 Target 50%
5% HBV
215
Proportion of diagnosed For persons who inject drugs
HBV persons receiving (PWID), number of sterile
appropriate treatment, 2018 needles per year, 2021 4
PAKISTAN • HEPATITIS ELIMINATION PROFILE
935,438
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
21,842
18,913
404,400
SVR data from government programs not readily available due to limited SVR12 testing,
making an accurate assessment of SVR rates difficult. Data from smaller hospital-
based studies or micro-elimination campaigns suggest an SVR rate of 90-95%
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
353,695
348,901
2.65 M
324,021
215,261
161,000
Number of persons treated 65,000
for HCV, cumulative,
2004-2020 19,22,26
2015 2016 2017 2018 2019 2020
STRATEGIC INFORMATION
Incidence
No national prevalence study has been
conducted since 2008 but provincial
studies conducted in 2018 for Punjab
Prevalence province and in 2019 for Sindh province
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
ROADBLOCKS
HCV contaminated blood transfusions are The Field Epidemiology and Laboratory Training
major contributors to HCV incidence in Program conducts routine surveilance of acute
Pakistan. Approximately half of the blood hepatitis B and C but not for chronic hepatitis
donors are not screened for HCV, HBV, and HIV and the case definition differs from WHO
ROADBLOCKS
Hepatitis B birth dose is not available across all provinces
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
ACHIEVEMENTS
INNOVATIONS
The COVID-19 response has led to large increase in the capcity for PCR testing, electronic
health reporting, and improved coordination across provinces and the federal capital
ACHIEVEMENTS
The Prime Minister set a target for July 2020 to June 2025 to screen 50% of the eligible population,
aiming to reach 69 M persons with anti-HCV screening and 5.15 M with PCR confirmation testing.
PAKISTAN • HEPATITIS ELIMINATION PROFILE
ROADBLOCKS
General population screening Scale-up of point-of-care testing is needed
implementation has been challenging
and further roll-out is needed HCV NAT and antigen testing remain expensive
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
No genotyping 16 Adopted
ACHIEVEMENTS
A model community-based, HCV “test & treat” An ambitious program for HCV Elimination was
PAKISTAN • HEPATITIS ELIMINATION PROFILE
program is underway in Punjab province announced by the Prime Minister in July 2019 and
is awaiting funding to start. This program aims
Cost of HCV treatment is US$ 120 for to treat 9.8 million HCV patients by 2030
12 weeks of SOF/VEL and US$35 (as of
June 2022) for 12 weeks for SOF/DCV
ROADBLOCKS
COVID-19 and limited funding has delayed implementation of
the Prime Minister’s HCV elimination program
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
Harm reduction for persons Not Developed The Global Fund for TB, AIDS,
who inject drugs (PWID) 12 and Malaria supports all active
harm reduction programs
INNOVATIONS
PAKISTAN • HEPATITIS ELIMINATION PROFILE
A number of successful HCV micro-elimination programs are running in the country, both in the
public and private sector, demonstrating the utility of such an approach in high prevalence areas
FINANCING
Funds from the Global Fund for TB, Adopted The Global Fund for TB, AIDS,
AIDS, and Malaria used for co-infected and Malaria supports all active
harm reduction programs
patients or harm reduction programs
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
ACHIEVEMENTS
Pakistan’s government introduced The Corporate Coalition for Viral Hepatitis Elimination in
a National Strategic Framework on Pakistan (CCVHEP) is made up of 12 leading companies
Hepatitis [NHSF] in October 2017 created to support the Government of Pakistan’s effort
to eliminate viral hepatitis in Pakistan by 2030
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
SOURCES
1. Pakistan Health Research Center, & World Health Organization. (n.d.). National Hepatits Strategic Framework (NHSF) for Pakistan
2017-21. https://www.globalhep.org/sites/default/files/content/action_plan_article/files/2020-04/Pakistan--national-hepatitis-
strategic-framework--09-01-2018.pdf
2. Institute of Health Metrics and Evaluation (IHME). Global burden of Disease Study 2019. https://www.globalhep.org/country-
progress/pakistan
3. WHO and UNICEF. Hepatitis B vaccination coverage, WHO Immunization Data portal. https://immunizationdata.who.int/pages/
coverage/hepb.html?CODE=PAK&ANTIGEN=&YEAR=
4. Ministry of National Health Services, Regulation and Coordination Government of Pakistan. (2015, March 31). Pakistan Global AIDS
Response Progress Report (GARPR) 2015. UNAIDS. https://www.unaids.org/sites/default/files/country/documents/PAK_narrative_
report_2015.pdf
5. WHO (2021). Accelerating access to hepatitis C diagnostics and treatment. https://www.who.int/publications/i/
item/9789240019003
6. Chhatwal J. et al. (2019). Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan. JAMA network open, 2(5),
e193613. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6512462/
7. WHO. HBV Country Profiles: Pakistan. https://whohbsagdashboard.surge.sh/#hbv-country-profiles
8. HepCoalition. (n.d.). mapCrowd. https://mapcrowd.org/en/compare-data
9. MedsPaL. (n.d.). MedsPaL Database. https://www.medspal.org/?countries%5B%5D=Pakistan&disease_
area%5B%5D=Hepatitis+C+(HCV)&page=1
10. Roche Diagnostics. Partnering for positive change in Pakistan. https://diagnostics.roche.com/global/en/c/heptatitis-elimination-
pakistan.html
11. Butt AS (2015). Epidemiology of Viral Hepatitis and Liver Diseases in Pakistan. Euroasian journal of hepato-gastroenterology, 5(1),
43–48. https://doi.org/10.5005/jp-journals-10018-1129 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578520/
12. Georgetown HIV Policy Lab. Pakistan. https://hivpolicylab.org/pk/
13. Harm Reduction International. Global state of harm reduction: 2019 updates. https://www.hri.global/global-state-of-harm-
reduction-2019
14. Kamani L, Ahmad BS, Kalwar HA (2020). Hepatitis-C Infection: Are we really committed to eliminate? Could it become the second
Polio for Pakistan?. Pak J Med Sci; 36(7):1742-1744. doi:10.12669/pjms.36.7.2804 https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC7674893/#ref5
15. Qureshi H, Bile M, Jooma R, et al. (2010). Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey
appealing for effective prevention and control measures. Eastern Mediterranean health journal = La revue de sante de la Mediterranee
orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit, 16 Suppl, S15–S23. https://pubmed.ncbi.nlm.nih.gov/21495584/
16. Government of Pakistan and WHO (2020). Guidelines for the Treatment of Persons Chronically Infected with Hepatitis C. https://
phrc.org.pk/assets/pakistan-national-hcv-treatment-guidelines-sample-2.pdf
17. Abbas Z et al. (2010). Management of Hepatitis B: Pakistan Society for the Study of Liver Diseases (PSSLD) Practice Guidelines.
Journal of the College of Physicians and Surgeons Pakistan. Vol. 20 (3): 198-20 https://www.jcpsp.pk/archive/2010/Mar2010/14.pdf
18. Data provided by Dr. Huma Qureshi, Pakistan National Focal Point for Hepatitis,.
19. Presentation by Dr. Huma Qureshi, Ex-Executive Director Pakistan Medical Research Council, Pakistan National Focal Point for
Hepatitis. International Meeting for Viral Hepatitis Elimination 2021 (December 3rd).
20. APEX Consulting (2019). Final Report - Population based Prevalence Survey of Hepatitis B&C Punjab, 2018. Data provided by Dr.
Huma Qureshi, Pakistan National Focal Point for Hepatitis, on 10 March 2022.
21. CDA Foundation (2021). Modeling for Pakistan Ministry of Health. Data provided by Dr. Huma Qureshi, Pakistan National Focal
Point for Hepatitis, on 10 March 2022.
PAKISTAN • HEPATITIS ELIMINATION PROFILE
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COALITION FOR GLOBAL HEPATITIS ELIMINIATION
28. Israr M, Ali F, Nawaz A, Idrees M, Khattak A, Ur Rehman S, et al. (2021). Seroepidemiology and associated risk factors of hepatitis B
and C virus infections among pregnant women attending maternity wards at two hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan.
PLoS ONE 16(8): e0255189. https://dx.plos.org/10.1371/journal.pone.0255189
29. Ahmad I. (2016). Prevalence of Hepatitis B and C Viral Infection Among Pregnant Women in Peshawar, Pakistan. Hepatitis monthly,
16(6), e36383. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27630725/
30. Nai Zindagi Trust. Last accessed 24 May 2022. https://www.naizindagi.org/prevention-and-harm-reduction/
31. Drug Regulatory Authority of Pakistan (DRAP). Products. Last accessed 25 May 2022. https://public.dra.gov.pk/rd/HTMLClient/
default.htm
PAKISTAN • HEPATITIS ELIMINATION PROFILE
WORKING TOGETHER,
WE WILL ACHIEVE ELIMINATION.
This National Hepatitis Elimination Profile (N-HEP) was developed by the Coalition for FOR MORE INFORMATION:
GLOBALHEP.ORG
Global Hepatitis Elimination. Funding for this N-HEP was provided by Gilead Sciences. [email protected]
The Coalition for Global Hepatitis Elimination retained final control over the content.
TASKFORCE.ORG
The Coalition thanks Dr. Huma Qureshi, the National Viral Hepatitis Focal Point, 330 W. PONCE DE LEON AVENUE
Dr. Saeed Hamid from Aga Khan University, and Parsa Trust for their input and DECATUR GA 30030
feedback on the development of this National Hepatitis Elimination Profile.
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