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Semin Liver Dis 2018; 38(03): 181-192
DOI: 10.1055/s-0038-1666841
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations

Jeffrey V. Lazarus
1   Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
,
Kelly Safreed-Harmon
1   Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
,
Mark R. Thursz
2   Department of Surgery and Cancer, Imperial College, London, United Kingdom
,
John F. Dillon
3   Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
,
Manal H. El-Sayed
4   Department of Pediatrics, Ain Shams University, Cairo, Egypt
,
Ahmed M. Elsharkawy
5   University Hospitals Birmingham, Mindelsohn Way, Birmingham, United Kingdom
,
Angelos Hatzakis
6   Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens Medical School, Athens, Greece
,
Michel Jadoul
7   Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
,
Tullio Prestileo
8   Infection Diseases Unit and Centre for Migration and Health, ARNAS, Civico-Benfratelli Hospital, Palermo, Italy
,
Homie Razavi
9   Center for Disease Analysis Foundation, Lafayette, Colorado
,
Jürgen K. Rockstroh
10   Department of Medicine I, University of Bonn, Bonn, Germany
,
Stefan Z. Wiktor
11   Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, Washington
,
Massimo Colombo
12   Department of Medicine, Clinical and Research Center, Humanitas Hospital, Rozzano, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
09 July 2018 (online)

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Abstract

The introduction of efficacious new hepatitis C virus (HCV) treatments galvanized the World Health Organization to define ambitious targets for eliminating HCV as a public health threat by 2030. Formidable obstacles to reaching this goal can best be overcome through a micro-elimination approach, which entails pursuing elimination goals in discrete populations through multi-stakeholder initiatives that tailor interventions to the needs of these populations. Micro-elimination is less daunting, less complex, and less costly than full-scale, country-level initiatives to eliminate HCV, and it can build momentum by producing small victories that inspire more ambitious efforts. The micro-elimination approach encourages stakeholders who are most knowledgeable about specific populations to engage with each other and also promotes the uptake of new models of care. Examples of micro-elimination target populations include medical patients, people who inject drugs, migrants, and prisoners, although candidate populations can be expected to vary greatly in different countries and subnational areas.

Keywords

health policy - hepatitis C - micro-elimination - health systems - models of care
 

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