Progress and challenges in the comprehensive management of chronic viral hepatitis: Key ways to achieve the elimination

Chronic viral hepatitis is a significant health problem throughout the world,which already represents high annual mortality.By 2040,chronic viral hepatitis due to virus B and virus C and their complications cirrhosis and hepatocellular carcinoma will be more deadly than malaria,vitellogenesis-inhibiting hormone,and tuberculosis altogether.In this review,we analyze the global impact of chronic viral hepatitis with a focus on the most vulnerable groups,the goals set by the World Health Organization for the year 2030,and the key points to achieve them,such as timely access to antiviral treatment of direct-acting antiviral,which represents the key to achieving hepatitis C virus elimination.Likewise,we review the strategies to prevent transmission and achieve control of hepatitis B virus.Finally,we address the impact that the coronavirus disease 2019 pandemic has had on implementing elimination strategies and the advantages of implementing telemedicine programs.

Costs incurred by patients with drugsusceptible pulmonary tuberculosis in semiurban and rural settings of Western India

Background:India reports the highest number of tuberculosis(TB)cases worldwide.Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB.Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar(western India)using an adapted World Health Organization costing tool.Methods:We conducted a descriptive cross-sectional study of adults,notified in the public sector and being treated for drug-susceptible pulmonary TB during January-June 2019,in six urban and three rural blocks of Bhavnagar region,Gujarat state,India.The direct and indirect TB-related costs,as well as patients’coping strategies,were assessed for the overall care of TB till treatment completion.Catastrophic costs were defined as total costs>20%of annual household income(excluding any amount received from cash transfer programs or borrowed).Median and interquartile range(IQR)was used to summarize patient costs.The median costs between any two groups were compared using the median test.The association between any two categorical variables was tested by the Pearson chi-squared test.All costs were described in US dollars(USD).During the study period,on average,one USD equalled 70 Indian Rupees.Results:Of 458 patients included,70%were male,62%had no formal education,71%lived in urban areas,and 96%completed TB treatment.The median(IQR)total costs were USD 8(5-28),direct medical costs were USD 0(0-0),direct non-medical costs were USD 3(2-4)and indirect costs were USD 6(3-13).Among direct non-medical costs,travel cost(median=USD 3,IQR:2-4)to attend health facilities were the most prominent,whereas the indirect costs were mainly contributed by the patient’s loss of wages(median=USD 3,IQR:0-6).Four percent of patients faced catastrophic costs,11%borrowed money to cover costs and 7%lost their employment;the median working days lost to TB was 30(IQR:15-45).A majority(88%)of patients received a median USD 43(IQR:41-43)as part of a cash transfer program for TB patients.Conclusions:Treatment completion was high and the costs incurred by TB patients were low in this setting.However,negative financial consequences occur even in low-cost settings.The role of universal cash transfer programs in such settings requires further study.