HCV Elimination Day Mini Policy Summit. Eliminating HCV in Greece

Transcription

1 HCV Elimination Day Mini Policy Summit Eliminating HCV in Greece

2 HCV Elimination Day / Mini HCV Policy Summit Welcome Chair: Georgios Kyrtsos, Member of the European Parliament Co-Chair: Angelos Hatzakis, Co-Chair of Hepatitis B&C Public Policy Association Moderator: George Kalamitsis, Chair of the Hellenic Liver Patient Association Prometheus

3 HCV Elimination Day / Mini HCV Policy Summit Georgios Kyrtsos Member of the European Parliament

4 HCV Elimination Day / Mini HCV Policy Summit Angelos Hatzakis Co-chair of Hepatitis B&C Public Policy Association

5 Presentation of the Hepatitis B & C Public Policy Association and the Elimination Manifesto ANGELOS HATZAKIS Professor of Epidemiology & Preventive Medicine National & Kapodistrian University of Athens, Medical School Co-Chair, Hepatitis B & C Public Policy Association HCV Elimination Mini Policy Summit Eliminating HCV in Greece, Hosted by MEP G. Kyrtsos European Parliament, 22 November 2017

6 Viral hepatitis involves several Policy Areas Health Policy (vaccination, diagnosis, screening, prevention, treatment) Social Policy (adoption, pregnancy, schools, institutionalized living, drug abuse) HBV policy Civil Liberties Policy (migration, travel)

7 Aims 1. To contribute and advocate for the development of European strategies against HBV and HCV. 2. To monitor and support the implementation of this strategy at European and national level. 3. To promote the WHO global strategy for elimination of viral hepatitis. 4. To contribute to the communication and actions of hepatitis stakeholders.

8 Directors Prof. Angelos Hatzakis, Co-Chair, Athens University Medical School (Greece) Prof. Michael Manns, Co-Chair, Hannover Medical School (Germany) Prof. Rafael Esteban, Co-Chair, Vall d Hebron University (Spain) Prof. George Papatheodoridis, Treasurer, Athens University Medical School (Greece) Members Prof. Maria Buti, Vall d Hebron University Hospital (Spain) Dr. Manuel Carballo, International Centre for Migration and Health (ICMH) (Switzerland) Prof. Massimo Colombo, Clinical and Research Center Humanitas, Rozzano (Italy) Prof. Antonio Craxi, University of Palermo (Italy) Prof. Patrick Marcellin, APHP University of Paris (France) Prof. Pierre van Damme, Viral Hepatitis Prevention Board & University of Antwerp (Belgium) Prof. Harry Janssen, UHN Liver Clinic, Toronto Western Hospital (Canada)

9 Members (continued) Prof. Markus Peck-Radosavljevic, Medical University Vienna (Austria) Nurdan Tozun, Acibadem University (Turkey) Heiner Wedemeyer, Hannover Medical School (Germany) Prof. Gamal Esmat, Cairo University Medical School Dr. David Goldberg, Health Protection (Scotland) Prof. Mark Thursz, Imperial College (London) Mr. Michael Ninburg, Hepatitis Education Project (US) Prof. Laurent Castera, University of Paris (France) Dr. Ricardo Baptista-Leite, Member of the Portuguese Parliament Mr. George Kalamitsis, NGO Prometheus, Athens, (Greece) Prof. Jeffrey Lazarus, University of Copenhagen, (Denmark) Affiliate Member Nikos Dedes, EATG, NGO Positive Voice (Greece) Corporate Secretary Ann Fox

10 Summit Conferences and High Level Meetings 1. Summit Conference Hepatitis B and Hepatitis C in Europe, under auspices of Belgian EU Presidency Brussels, October Summit Conference Hepatitis B and C in Mediterranean and Balkan Countries, under the auspices of the Cyprus EU Presidency Nicosia Cyprus, December High-Level Meeting Economic crisis and healthcare ensuring access to public health services: the case of hepatitis B and C, under the auspices of the Greek EU Presidency and the Greek Ministries of Health and of Foreign Affairs Athens, June st EU HCV Policy Summit Hepatitis C: The beginning of the end - key elements for successful European and national strategies to eliminate HCV in Europe Brussels, February 2016 Each Summit was attended by delegates from countries

11 2nd HCV Policy Summit on the elimination of hepatitis C in Europe by 2030 Securing sustainable funding for hepatitis elimination plans 2018, Brussels

12 On 17 February, the first EU HCV Policy Summit provided for a successful platform to initiate a campaign calling for the Elimination of Hepatitis C in Europe by 2030 The overall objectives of our engagement are: Put forward and discuss concrete ideas towards the Elimination of Hepatitis C in Europe Launch the Elimination Manifesto which was signed by stakeholders including national and EU policy-makers such as the Chair of the informal interest group in the European Parliament Friends of the Liver

13 The European HCV Elimination Manifesto The Manifesto was supported by 9 organisations George Papandreou Former Greek Prime Minister Cristian-Silviu Buşoi Member of the European Parliament The Manifesto can still be signed online Judith Kirton-Darling Member of the European Parliament

14 European HCV Policy Summit Speakers 32 high profile speakers including: Vytenis Andriukaitis European Commissioner for Health European Commission Angelos Hatzakis Co-Chair HepBC PPA & University of Athens Michael P. Manns Co-Chair HepBC PPA & Hannover Medical School Stephan Wiktor Team Lead World Health Organization Ricardo Baptista Leite Former Member of the Portuguese Parliament Cristian-Silviu Buşoi Co-Chair of the European Parliament Friends of the Liver Group Ingo Michels Head of Unit of the German Federal Drug Commissioner Alexis Goosdeels Director EMCCDA

15 The HCV Elimination Days in European Parliament The HepBC PPA organised a series of expert political roundtable / mini-summits in Brussels (40 people max.), with EU and national policy-makers that have a national focus in 2017 The selected countries are Romania, Portugal and Greece. Aims - Promote the Elimination Manifesto and expedite action at national level and EU level by bringing the two together - Discuss required policy changes to achieve elimination of HCV by 2030 and the concrete steps that need to be taken (at EU and at national level) to ensure the implementation of the Elimination Manifesto

16 HepBCPPA Mini HCV Policy Summits 2017 Elimination Day in European Parliament Host MEP Romania Elimination Day Portugal Elimination Day Greece Elimination Day MEP Cristian-Silviu Buşoi MEP Carlos Zorrinho MEP Georgios Kyrtsos

17 HepBCPPA Activities Organizes European and National Summits on Viral Hepatitis National meetings to promote the Elimination Manifesto (the first two meetings were held in Greece and Germany in 2016) Advocates at National and European level Informs its 5000 stakeholders through its Newsletter and Social Media channels Publishes articles in scientific journals Educational material on the theme of viral hepatitis elimination Develops guidelines for policy-makers Develops a data base of national policy makers of EU 28 Innovative Finance Initiative to tackle HCV

18 Elimination Manifesto Elimination Manifesto is on the website of HepBCPPA

19 THANK YOU FOR YOUR ATTENTION

20 HCV Elimination Day / Mini HCV Policy Summit George Kalamitsis Chair of the Hellenic Liver Patient Association Prometheus

21 HCV Elimination Day / Mini HCV Policy Summit Setting the scene: the Hellenic response to HCV elimination Speakers: Panos Papadopoulos, Chief of Minister of Health s Cabinet Nikolaos Manios, Member of Hellenic Parliament, Chair of Standing Committee on Social Affairs. SYRIZA - GUE/NG

22 HCV Elimination Day / Mini HCV Policy Summit the Hellenic response to HCV elimination Panos Papadopoulos Chief of Minister of Health s Cabinet

23 HCV Elimination Day / Mini HCV Policy Summit the Hellenic response to HCV elimination Nikolaos Manios Member of Hellenic Parliament, Chair of Standing Committee on Social Affairs. SYRIZA - GUE/NG

24 HCV Elimination Day / Mini HCV Policy Summit Eliminating HCV in Greece: the challenges Speakers: Vana Sypsa, Assistant Professor at University of Athens, School of Medicine Kyriakos Souliotis, Associate Professor of Health Policy at the Faculty of Social and Political Sciences, University of Peloponnese

25 HCV Elimination Day / Mini HCV Policy Summit Eliminating HCV in Greece: the challenges Vana Sypsa Assistant Professor at University of Athens, School of Medicine

26 Screening in the general population: objectives and effectiveness indicators Vana Sypsa Ass. Professor of Epidemiology & Preventive Medicine National and Kapodistrian University of Athens, Greece HCV Elimination Mini Policy Summit Eliminating HCV in Greece European Parliament,

27 Targets for diagnosis and treatment in Greece Diagnosis Treatment 100% 90% treatments/year 80% % % 20% 19%-25% treatments/year 0%

28 Target populations High prevalence groups People who inject drugs, HIV(+) persons, prisoners, others (thalassemia etc) General population Approx anti-hcv(+) persons Approx anti-hcv(+) persons

29 Increasing diagnosis in the general population: Screening Screening identification of infected individuals who have not yet developed symptoms Various strategies (WHO, 2017) 1. Focused testing in most affected populations (high prevalence populations or presence of signs/symptoms) 2. One-time universal screening of adults born between specific years due to a disproportionately high prevalence of HCV in this birth cohort birth cohort screening 3. Routine screening (for settings with high prevalence)

30 Saraswat et al., 2015 Identifying the appropriate birth cohort in Greece % anti-hcv(+) according to age and gender

31 Anticipated efficacy of screening of the general population in Greece Adult population (20-80 yrs) (~85% of cases) (~65% of cases) anti-hcv prevalence 0.81%-1.5% 0.83%-1.8% 0.84%-2.0% Number of anti-hcv(+) Number of test per one anti-hcv(+) case Number of test per one new anti-hcv(+) case To identify 1,000 new anti-hcv(+) cases : approximately 100,000 persons will have to be screened

32 Main points It is necessary to expand screening in Greece Limited effectiveness of current testing strategies Benefits of HCV care and of treatment for the patient as well as for public health Reaching WHO elimination targets In the Greek National Viral Hepatitis C Action Plan One-time universal HCV screening among persons born between (birth-cohort screening) However, the uptake of this screening may be low unless specific interventions are implemented

33 HCV Elimination Day / Mini HCV Policy Summit Eliminating HCV in Greece: the challenges Kyriakos Souliotis Associate Professor of Health Policy at the Faculty of Social and Political Sciences, University of Peloponnese

34 BARRIERS IN ACCESS TO TREATMENT WHAT NEXT? Kyriakos Souliotis Associate Professor of Health Policy & Vice Rector University of Peloponnese, Greece Senior Associate Director, Department of Health Policy LSE Enterprise - Medical Technology Research Group, UK Brussels, 22 November 2017

35 THE EXTERNAL ENVIRONMENT Undiagnosed population Diagnosed population Source: OECD, Health Database, 2017

36 HEALTH SYSTEM PERFORMANCE Undiagnosed population Source: World Economic Forum: Greece Country Profile The Inclusive Growth and Development Report 2017

37 WHERE ARE WE ON THE PATHWAY TO ELIMINATION? Undiagnosed population Diagnosed population

38 People who know their HCV status have to go through a certain pathway to access treatment Diagnosed population Testing Diagnosis Treatment HCV- Ab Elastography Reimbursement criteria HCV- RNA Specialist diagnosis Access to product HCV- genotype Registy Access to pharmacy

39 Critical barriers still persist for all populations Diagnosed population Testing Diagnosis Treatment HCV- Ab Elastography Criteria HCV- RNA Specialist diagnosis Access to product HCV- genotype Registry Access to pharmacy

40 Which further aggravate the status of more vulnerable populations PWIDs in OKANA programmes High risk PWIDs (active street use) DO NOT MEET CRITERIA DO NOT MEET CRITERIA * Of the 1764 >=F2, approximately 600 have had an elastography through ΠΡΟΜΗΘΕΑΣ and 200 have received newer DAAs

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45 62% of patients are in a bad economic situation

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58 Bringing it all together WHAT NOW? Diagnosed population Undiagnosed population Universal access to care Screening HCV genotype, elastography, criteria PWIDs, HIV, Thalassemia, Prisons Birth cohort Special populations Towards elimination

59 Knowing is half the battle! Doing is the other half

60 Thank you very much Prof. Kyriakos Souliotis

61 HCV Elimination Day / Mini HCV Policy Summit Potential solutions to eliminating HCV Speakers: George V. Papatheodoridis, President of the Hellenic Association for the Study of the Liver Alexis Goosdeel, Director of the European Monitoring Centre for Drugs and Drug Addiction Ricardo Baptista Leite, Member of the Portuguese Parliament Charles Gore, President of the World Hepatitis Alliance, Chief Executive of Hepatitis C Trust

62 HCV Elimination Day / Mini HCV Policy Summit Potential solutions to eliminating HCV George V. Papatheodoridis, President of the Hellenic Association for the Study of the Liver

63 Concrete suggestions to eliminate HCV in Greece George Papatheodoridis Professor in Medicine & Gastroenterology, Medical School of National & Kapodistrian University of Athens President of the Hellenic Association for the Study of the Liver

64 Estimated number of patients for HCV elimination in Greece Hellenic National Plan for Hepatitis C, July 2017 Minimum numbers of patients who should be treated with DAAs annually : 4,700 patients : 6,800 patients : 6,800 patients : 7,000 patients Negotiation agreement for DAAs, June 2017 DAAs therapy in 5400 ΗCV patients from July 2017 to August 2018 or ~4630 HCV patients within 12 months

65 Estimated number of HCV patients in Greece Chronic HCV patients, n Undiagnosed (75%), n Diagnosed (25%) & untreated (40%), n Hprolipsis 1 Including high-risk groups 74,200 (54, ,000) 55,650 7,420 Τelephonic survey 2 Including high-risk groups 134,400 (75, ,800) 100,800 13,440 1 Touloumi G et al. EASL 2017; 2 Papatheodoridis G et al. J Viral Hepat 2015,22:

66 HCV PATIENTS IN GREEK LIVER CENTERS IN 2015 (Similar data for 2016 AASLD 2017) consecutive HCV patients from 5 liver centers in 2015 (Αthens 2, Thessaloniki 1, Larissa 1, Patra 1) 80 HCV 60 patients, % F0-F1 F2-F3 naïve F3 exper.-f4-lt M Papatheodoridi et al. Ann Gastroenterol Patients treated with DAAs F3 experienced-f4-lt: ~1000 (ΕΟPYY 2015/2016) F2-F3 naive: ~1000, F0-F1 special groups: ~500? = Total: ~2500 /year

67 HCV patients in Greece in 2017 Undiagnosed Asymptomatic screening Diagnosed, not treated Awareness of access to DAA General population Micro-elimination programs High risk groups General population (including past PWID) High risk groups (including current PWID) Dead, Lost DAAs - SVR

68 3. Arms and actions of the Hellenic National plan for hepatitis C 3.1. Re-organization of structures and services 3.2. Policies for implementation and development of the plan o 1 st Arm: Health behavior, prevention and public awareness o 2 nd Arm: Asymptomatic screening o 3 rd Arm: Diagnosis and treatment o 4 th Arm: Follow-up and chronic care

69 Policies for implementation and development of the plan 2 nd Arm: Asymptomatic screening Action 1: Programs of asymptomatic screening for the general population Key implementation actions Birth cohort screening programs for individuals born between Inclusion of anti-hcv testing in the recommendations for check-up in the target population Organization of one week of HCV test within the annual European HIV- Hepatitis Testing Week Promotion of voluntary diagnostic testing for viral hepatitis Action 2: Programs of asymptomatic screening for high-risk groups

70 Policies for implementation and development of the plan 3 rd Arm: Diagnosis and treatment Action 2: Secure access of appropriate number of patients at the appropriate treatment for HCV elimination Key implementation actions Support to liver centers Wider use and improvement of hepatitis C registry Increase of the number of DAA treated patients Easier process for treatment onset Improvement of health care services focusing on patients needs, particularly for high-risk group patients (eg PWID) Programs for reduction of reinfection risk at high-risk groups

71 Concrete suggestions to eliminate HCV in Greece Implementation of the National Hepatitis C plan Challenging but feasible; mostly depending on the Ministry of Health

72 HCV Elimination Day / Mini HCV Policy Summit Potential solutions to eliminating HCV Alexis Goosdeel Director of the European Monitoring Centre for Drugs and Drug Addiction

73 Key elements for an effective HCV elimination strategy from the EMCDDA perspective Alexis GOOSDEEL Director HCV Elimination Mini Policy Summit Eliminating HCV in Greece 22 November 2017, EP Brussels

74 Global figures Estimated 12 million PWID worldwide One in two PWID has HCVantibodies (6 million) > 80% of PWID living with HIV are co-infected with HCV UN World Drug Report 2016 Injection drug use accounts for 23% of new HCV infections WHO Global Hepatitis Report

75 Why PWID are a priority on the elimination agenda in Europe People who inject drugs (PWID) represent the majority of the hepatitis C virus disease burden in Europe; - 40%-80% anti-hcv prevalence among tested PWID - 80% of all new infections with known transmission route - major risk group for transmission of infections Clear HCV treatment recommendation but testing and referral of PWID insufficient; HCV elimination among PWID only possible when scaling up primary prevention: package of effective measures incl. NSP, OST. 75

76 Global monitoring framework Epidemiology HCV care Data for policy making and intervention planning Prevention Diagnosis 76

77 Key elements for HCV elimination : EMCDDA focus on PWID Up-to-date PWID estimates Monitor HCV care policies for PWID EMCDDA monitoring and support countries Monitor harm reduction coverage Promote best practice standards 77

78 Good practices: European Responses Guide 78

79 emcdda.europa.eu twitter.com/emcdda facebook.com/emcdda youtube.com/emcddatube flickr.com/photos/emcdda 79

80 HCV Elimination Day / Mini HCV Policy Summit Potential solutions to eliminating HCV Ricardo Baptista Leite Member of the Portuguese Parliament

81 Hepatitis C: Policy in Action 22 nd November 2017 European Parliament, Brussels Ricardo Baptista Leite, MP, MD, PhD(c) Medical Doctor and Member of the Portuguese Parliament Member of the Parliamentary Health Committee Foreign Affairs Committee Founder and President of UNITE Parliamentarians Network to End HIV/AIDS, Viral Hepatitis and Tuberculosis Head of Public Health Católica University of Portugal Guest Lecturer NOVA Medical School Guest Lecturer NOVA Information Management

82 HIV in Portugal Number of New HIV Infections st Dx HIV in Portugal HAART Drug Addiction as Health Challenge

83 HIV in Portugal

84 HIV in Portugal 2011 HIV

85 HIV in Portugal Number of New HIV Infections HEP C 1st Dx HIV in Portugal HAART Drug Addiction as Health Problem TROIKA T&T Fast Track Cities

86 Hepatitis C: Policy in Action Hepatitis C in

87 Hepatitis C: Policy in Action HCV Paradigm Shift May 2014 Católica University of Portugal Institute of Health Sciences Public Health Unit Consensus Method Review scientfic data Collect data from main stakeholders (Think Tank) Consensus paper to support future decisions on how to manage hepatitis C in Portugal, from a public policy perspective: from prevention to

88 Hepatitis C: Policy in Action HCV The Research to Policy Gap June - December 2014 Only ~50 patients with Hepatitis C were treated with 3rd generation antiviral drugs (special authorizations) Negotiations between Ministry of Health and Pharma Industry went on behind closed doors. Absolute uncertainty on what would be the outcome of those negotiations. Private hospitals were charging over 100k Euros to treat Hepatitis C. Advocats from all fields were demanding a decision, including a possible patent violation (under the Doha treaty), to save

89 Hepatitis C: Policy in Action The Tipping Point February 2015 DON T LET ME DIE! José Carlos

90 Hepatitis C: Policy in Action HCV When Research meets Policy February 2015 The Ministry of Health announced an agreement with Gilead Sciences and Harvoni was fully funded for all patients with Hepatitis C. Risk sharing model was adopted. The Ministry agreed on paying per patient that is clinically cured (not per number of weeks of treatment nor per number of patients treated) and the payment procedures were fully centralized. Volume-based agreement: Price paid is inversely proportional to the number of patients treated. National Action Plan for Hepatitis C and the review of the national HCV treatment guidelines were announced and are currently being prepared by a panel of experts. Centralized registry database was commissioned and is currently used by

91 Hepatitis C: Policy in Action Hepatitis C in Portugal Today Over 17,591 patients that have been diagnosed with chronic HCV in the NHS and their treatment has been authorized patients have initiated treatment PATIENTS CURED 96,5% SVR Source: Ministry of Health PT, July

92 Hepatitis C: Policy in Action Hepatitis C in Portugal Health Outcomes (Feb 2017) pathtozero.eiu.com Averted premature liver related deaths Gained life years Averted 339 liver transplants, liver cancers, cases of chirosis Savings million Euros on treatment costs related to hepatitis c complications Source: Martins J, Rodrigues J, Paula Martins A, Andreozzi V, Vandewalle B, Félix J, Castro Alves E, Mota-Filipe H. Long-Term Effect of the Portuguese Universal Access Program to New Generation Direct-Acting Antivirals for Treatment of Hepatitis C. EASL 2016, Barcelona, Poster

93 It s time to end HIV/AIDS, Viral Hepatitis and Tuberculosis. It s time to UNITE. With the support and under the auspices of

94 HCV Elimination Day / Mini HCV Policy Summit Potential solutions to eliminating HCV Charles Gore President of the World Hepatitis Alliance Chief Executive of the Hepatitis C Trust

95 First EU HCV Policy Summit on the elimination of hepatitis C: - Provided political vision and tangible goal of HCV elimination - Set up a successful platform to initiate a campaign calling for the elimination of hepatitis C in Europe by 2030 EU HCV Elimination Manifesto - Sets out high-level policy asks to enable elimination of HCV - Brings a broad community around shared policy asks - Represents a tangible commitment that can be endorsed also by national policy-makers HCV European Policy Guidelines - Provide concrete suggestions for the next steps in securing the implementation of the Elimination Manifesto

96 HCV Guidelines: developed in collaboration with leading experts in the field; provide examples of actions to be taken at national level that are realistic and achievable within a short time-frame; support policy-makers in understanding what kind of changes they can make in their country to contribute to the elimination of HCV by policy asks of the EU HCV Elimination Manifesto Translated into: Environmental context Specific recommendations Examples of policy actions.for each policy ask

97 WHAT CAN BE DONE BY POLICY-MAKERS? Develop and implement a national plan to eliminate HCV and allocate adequate resources Ensure key healthcare workers are aware of the steps to be taken for HCV elimination Make provision for educational programmes and on-going training for clinicians Support and implement European Hepatitis Awareness Week Produce an annual report on implementation of the national plan Where possible, make link to EU level to strengthen actions to eliminate HCV Ministry of Health National Surveillance Agency Members of Parliament Members of the EU Parliament Create a cross-party group of parliamentary champions Raise the issue in parliament enough to put and keep it on the political agenda Work with media to disseminate messages amongst policy-makers and the broader public Convene multi-stakeholder roundtable meetings Sign the Manifesto and encourage others to do so Monitor progress on HCV elimination Systematically produce data Hold dialogue with other countries to improve and align surveillance systems Create a cross-party group of Parliamentary champions Lobby the EU commission for action Support the call for a joint framework on HIV/AIDS, TB and viral hepatitis

98 HCV Elimination Day / Mini HCV Policy Summit The way forward: how to eliminate HCV in Greece (Discussion) Moderator: George Kalamitsis - Hepatitis B&C Public Policy Association

99 Sources of information Physicians have not been officially informed Their sources of information regarding both the National Action Plan as well as the negotiation between EOPYY and major pharmaceutical companies are: Word of mouth: Hepatologists have been awaiting this development to happen and discussed it among colleagues. The Hellenic Association for the study of the liver has informed its members through about the National Action Plan and has posted it on its site. Recent Hepatology congresses (the national Larisa congress has been particularly noted) have had dedicated sessions to the new directives for HCV treatment as a result of the EOPYY / Pharma companies negotiation and the National Action Plan. Medical representatives of Pharma companies whose products are prescribed according to the EOPYY / Pharma companies negotiation have informed them stressing the importance of prescribing treatment to an increased number of patients. Έστειλε η Ελληνική Εταιρία Μελέτης Ήπατος. Το μόνο επίσημο ήταν αυτό. Επίσημα δεν υπάρχει καμία ενημέρωση. Το έμαθα από τα στόματα των άλλων συναδέλφων. Επίσημα δεν έγινε από κανέναν καμία διαφήμιση. Σας το λέω υπεύθυνα, τίποτα. Επίσημα σε μένα δεν έφτασε κάτι. Οι φαρμακευτικές μου έδωσαν βέβαια αντίγραφο αυτών που είπε ο ΕΟΠΥΥ.

100 To treat or not to treat? The answer depends both on the specific physician s attitude towards PWIDs as an entity and the sub-category the particular patient belongs to: Ex- PWIDs Are treated by all physicians they are no different from any other HCV patient. PWIDs on addiction cessation programs Most physicians will treat them in case they consider (by assessing them through their clinical experience) that they are reliable enough to follow instructions and successfully complete the 2 or 3 month treatment. A couple of physicians however refuse to treat them until they have completed such programs or will only treat those on dry programs and methadone substitution programs. Active PWIDs Considered to constitute the largest pool of HCV patients Most physicians do not treat them, as they believe that they will fail to comply they consider that treatment failure will be inevitable. Exception: some physicians treat them if they judge them to be reliable e.g. they come to appointments, they have a relatively supportive environment by treating them they protect others from contacting HCV in the future. Υπάρχουν γιατροί που λένε ότι με αυτούς δεν ασχολούμαι. Έχει δικαίωμα ο γιατρός να διώξει τον ασθενή.... Δεν παίρνει θεραπεία [ο χρήστης]. Σε αυτό είμαι κάθετοςείμαστε σε μια φάση που υπάρχουν άνθρωποι οι οποίοι πεινάνε. Το να πετάμε λεφτά το θεωρώ μεγάλο λάθος.

101 ΑΣΘΕΝΕΙΣ ΜΟΝΑΔΩΝ ΟΚΑΝΑ 101 ΣΥΝΟΛΙΚΑ ΣΤΟΥΣ ΑΣΘΕΝΕΙΣ ΤΩΝ 57 ΜΟΝΑΔΩΝ ΟΚΑΝΑ, ΟΙ ΥΠΗΡΕΣΙΕΣ ΔΙΑΓΝΩΣΗΣ ΚΑΙ ΔΙΑΣΥΝΔΕΣΗΣ ΜΕ ΘΕΡΑΠΕΙΑ ΕΙΝΑΙ ΔΙΑΘΕΣΙΜΕΣ ΚΑΙ ΠΡΟΣΒΑΣΙΜΕΣ ΣΕ ΠΟΛΥ ΠΕΡΙΟΡΙΣΜΕΝΟ ΒΑΘΜΟ στοιχεία επικράτειας, πρώτη καταγραφή από Προμηθέα, καταγραφή σε εξέλιξη Μονάδες ΟΚΑΝΑ Γενικός πληθυσμός Σχόλια HCV-Ab 82% ΟΚΑΝΑ HCV RNA 68% ΟΚΑΝΑ HCV Genotype Ελαστογραφία 2 νοσοκομεία Αττική, 1 Λάρισα, 1 Βόλος (50 ευρώ κόστος εξέτασης) Ηπατολόγος Λοιμωξιολόγος Πρόσβαση με βάση τα κριτήρια αποζημίωσης 28% ΟΚΑΝΑ 40% ΟΚΑΝΑ 60% Γενικός πληθυσμός Διαθεσιμότητα φαρμάκων Πρόσβαση σε φαρμακείο ΕΟΠΥΥ

102 HCV Elimination Day / Mini HCV Policy Summit Wrap-up and signing of the Elimination Manifesto Angelos Hatzakis, Hepatitis B&C Public Policy Association Georgios Kyrtsos, Member of the European Parliament

103 HCV Elimination Day / Mini HCV Policy Summit We thank you for your attendance & invite you to sign the HCV Elimination Manifesto!