The Government of India has recently launched a National Viral Hepatitis Control Program (NVHCP) to combat viral hepatitis.

Background Information:

Viral hepatitis is a global public health problem of epidemic proportions that caused 1.34 million deaths in 2015- a number comparable to deaths caused by tuberculosis and higher than those caused by HIV.  Infection can be caused by the five known hepatitis viruses – A, B, C, D and E (HAV, HBV, HCV, HDV and HEV). Many of these infections are preventable. Hepatitis B and C are responsible for 96% of overall hepatitis mortality.

Viral hepatitis is increasingly being recognized as a public health problem in India.
HAV and HEV are important causes of acute viral hepatitis and acute liver failure (ALF). Due to paucity of data, the exact burden of disease for the country is not established. However, available literature indicates a wide range and suggests that HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure cases in
India. It is further reported that HEV 10-40% of acute hepatitis and 15-45% of acute liver failure.

Hepatitis B surface antigen (HBsAg) positivity in the general population ranges from 1.1% to 12.2%, with an average prevalence of 3-4%. Anti-Hepatitis C virus (HCV) antibody prevalence in the general population is estimated to be between 0.09-15%. Since India has one-fifth of the world’s population, it accounts for a large proportion of the worldwide HBV burden. India harbours 10-15% of the entire pool of HBV carriers of
the world. It has been estimated that India has around 40 million HBV carriers. About 15-25% of HBsAg carriers are likely to suffer from cirrhosis and liver cancer and may die prematurely.

In India, unsafe injections lead to very high incidence of infections in the magnitude of:
• 260,000 HIV infections (5% of global burden)
• 21 million HBV infections (32% of global burden)
• 2 million HCV infections (40% of global burden)

There are several components that are existing in the different programs of Government of India like UIP, Swachh Bharat Mission, safety of blood and blood products, safe drinking water and sanitation, that are directly or indirectly related to the prevention of viral hepatitis.

Currently, some states are providing treatment and care for patients with hepatitis C with the newer class of directly acting anti-viral drugs that are safe, effective and easy to administer with high cure rates. Some healthcare facilities are also providing antiviral treatment for chronic Hepatitis B infection/disease. However, as the NVHCP is rolled out under National Health Mission (NHM), all the state programs shall be transitioned to the National Program and will align with the National protocols and guidance on testing as well as management of the all the different types of viral hepatitis ( namely A, B, C, D and E viruses).

Key Messages:

Aims of the NVHCP:

1. Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030.
2. Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepatocellular carcinoma (liver cancer).
3. Reduce the risk, morbidity and mortality due to Hepatitis A and E.

Objectives of NVHCP:

1. Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high-risk groups and in hotspots.
2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare.
3. Develop standard diagnostic and treatment protocols for management of viral hepatitis and its complications.
4. Strengthen the existing infrastructure facilities, build capacities of existing human resource and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country.
5. Develop linkages with the existing National programmes towards awareness, prevention, diagnosis and treatment for viral hepatitis.
6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.

Program Strategies:

Preventive and promotive interventions with focus on awareness generation, safe
injection and socio cultural practices, sanitation and hygiene, safe drinking water
supply, infection control and immunization.

Co-ordination and collaboration with different Ministries and departments, NACP for
safety of blood and blood products and with IDSP and NACP for surveillance

Increasing access and promoting diagnosis and providing treatment support for
patients of viral hepatitis.

Building capacities at national, state, district and sub district levels upto PHC and
Health and Wellness center in a phased manner.

Program Components:

Preventive component: This remains the cornerstone of the initiative. It will include

1. Awareness generation
2. Immunization of Hepatitis B (birth dose, high risk groups, health care workers)
3. Safety of blood and blood products
4. Injection Safety, safe socio-cultural practices
5. Safe drinking water, hygiene and sanitary toilets

Diagnosis and Treatment:

1. Screening of pregnant women for HBsAg to be done in areas where institutional deliveries are <80% to ensure their referral for institutional delivery for birth dose Hepatitis B vaccination.
2. Free screening, diagnosis and treatment for both hepatitis B and C would be made available at all levels of health care in a phased manner.
3. Provision of linkages, including with private sector and not for profit institutions, for diagnosis and treatment.
4. Engagement with community/peer support to enhance and ensure adherence to treatment and demand generation.

Monitoring and Evaluation:

Monitoring and Evaluation, Surveillance and Research effective linkages to the surveillance system would be established and operational research would be undertaken through DHR. Standardised M&E framework would be developed and an online web based system established.

Training and capacity Building:

This would be a continuous process and will be supported by NCDC, ILBS and state tertiary care institutes and coordinated by NVHCP. The hepatitis induction and update
programs for all level of health care workers would be made available using both, the traditional cascade model of training through master trainers and various platforms available for enabling e-learning and e-courses.

Implementation Structure:

The program will have two prongs-

1. Program management
2. Service Delivery Component

Program Management

The initiative will be coordinated by the units at the centre and the states as under:

• National Viral Hepatitis management unit(NVHMU)
• State Viral Hepatitis management unit(SVHMU)
• District Viral Hepatitis management unit (DVHMU)

Service Delivery Component:

This will include the following two aspects:

1. Synergies with the existing programs and relevant ministries of Government of India
2. New Interventions- Diagnosis and Management of Viral Hepatitis with focus on treatment of Hepatitis B&C

Useful Links:

Link to the Ministry of Health & Family Welfare web site:

https://mohfw.gov.in

Link to the Guidelines of NVHCP:

https://mohfw.gov.in/newshighlights/guidelines-nvhcp