What Is the Viral Hepatitis National Strategic Plan?
The Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021-2025 (Viral Hepatitis Plan, Plan) provides a framework to eliminate viral hepatitis as a public health threat in the United States by 2030. The Viral Hepatitis Plan focuses on hepatitis A, hepatitis B, and hepatitis C—the three most common hepatitis viruses that have the most impact on the health of the nation. The Plan is necessary as the nation faces unprecedented hepatitis A outbreaks, progress on preventing hepatitis B has stalled, and hepatitis C rates nearly tripled from 2011 to 2018. The Plan provides goal-oriented objectives and strategies that can be implemented by a broad mix of stakeholders at all levels and across many sectors, both public and private, to reverse the rates of viral hepatitis, prevent new infections, improve care and treatment and ultimately eliminate viral hepatitis as a public health threat in the United States.
The Viral Hepatitis Plan builds on three prior National Viral Hepatitis Action Plans, which covered the periods of 2011–2020. The Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021–2025 is the first Plan to aim for elimination of viral hepatitis as a public health threat in the United States.
The Viral Hepatitis Plan was developed under the direction of the Office of Infectious Disease and HIV/AIDS Policy (OIDP) in the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS), in collaboration with subject matter experts from across the federal government and with input from a wide range of stakeholders including the public.
Why do we need a Viral Hepatitis National Strategic Plan?
Viral hepatitis is a significant public health threat that puts people who are infected at an increased risk for serious disease and death. The Viral Hepatitis Plan is necessary as the nation faces unprecedented hepatitis A outbreaks, progress on preventing hepatitis B has stalled, hepatitis C rates nearly tripled from 2011 to 2018, and, as of 2016, an estimated 3.3 million people were chronically infected with hepatitis B and hepatitis C. Viral hepatitis is associated with substantial health consequences, stigma, and discrimination. It takes a large toll on individuals as well as communities, many of which are disproportionately impacted. Collectively, viral hepatitis costs people, health systems, states, and the federal government billions of dollars each year.
Despite the availability of effective clinical interventions, including vaccines, diagnostic tests and therapeutics, new or acute viral hepatitis infections have increased in recent years.
- From 2014 to 2018, the rate of new hepatitis A cases increased by 850%, the rate of acute hepatitis B increased by 11%, and the rate of acute hepatitis C cases increased by 71%.
- As of 2016, nearly 3.3 million people in the United States were living with chronic viral hepatitis—an estimated 862,000 with hepatitis B and 2.4 million with hepatitis C.
Surveillance data collected by the Centers for Disease Control and Prevention (CDC) reveal the following trends:
- Hepatitis A: The hepatitis A incidence rate decreased by greater than 95% from 1996 to 2011. However, the rate of new cases increased by 850% from 2014 (0.4 cases per 100,000) to 2018 (3.8 cases per 100,000) primarily because of large person-to-person outbreaks among people who use drugs and people experiencing homelessness. Hepatitis A is preventable by a safe and effective vaccine.
- Hepatitis B: Despite the availability of a safe and effective vaccine, the rate of acute hepatitis B cases increased 11% from 2014 (0.9 per 100,000) to 2018 (1.0 per 100,000). The rate of infection increased even more dramatically in states hardest hit by the opioid crisis. Injection drug use (IDU) and sexual transmission are risk factors associated with rising acute hepatitis B cases in the United States.
- Hepatitis C: The rate of acute hepatitis C cases increased 71% from 2014 (0.7 per 100,000) to 2018 (1.2 per 100,000), with two-thirds of cases occurring among persons aged 20–39 years, the age group most impacted by the opioid crisis.
All three viral hepatitis infections disproportionately impact certain populations, many of which experience other significant health and social inequities. The escalation of hepatitis B and hepatitis C infections is correlated with an increase in substance use disorders (SUDs) and injection drug use (IDU).
Viral Hepatitis National Strategic Plan
The United States will be a place where new viral hepatitis infections are prevented, every person knows their status, and every person with viral hepatitis has high-quality health care and treatment and lives free from stigma and discrimination.
This vision includes all people, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographic location, or socioeconomic circumstance.
Five high-level goals frame the Viral Hepatitis Plan:
- Prevent new viral hepatitis infections
- Improve viral hepatitis–related health outcomes of people with viral hepatitis
- Reduce viral hepatitis–related disparities and health inequities
- Improve viral hepatitis surveillance and data usage
- Achieve integrated, coordinated efforts that address the viral hepatitis epidemics among all partners and stakeholders
Each of the goal areas present evidence-based objectives and strategies that stakeholders can use that are most likely to contribute toward achieving national goals to eliminate the public health threat of viral hepatitis.
The Viral Hepatitis Plan covers the most common types of viral hepatitis: hepatitis A, hepatitis B, and hepatitis C—the hepatitis viruses that most significantly impact the health of the nation. The Plan provides a framework to control the viral hepatitis epidemics and eliminate viral hepatitis as a public health threat in the United States by 2030. Elimination is defined in the Plan and by the World Health Organization (WHO) as a 90% reduction in new chronic infections and a 65% reduction in mortality, compared to a 2015 baseline, although the Plan uses 2017 data as a baseline. The Viral Hepatitis Plan is designed to facilitate a whole-person health perspective and whole-of-nation response to achieve elimination of viral hepatitis as a public health threat.
The Viral Hepatitis Plan emphasizes viral hepatitis as part of a syndemic, which occurs when health-related problems—such as viral hepatitis, HIV, sexually transmitted infections (STIs), and substance use disorders (SUDs) —cluster by person, place, or time and interact synergistically. The syndemic also includes social determinants of health, stigma, discrimination, and mental health. This complex, multifactorial environment must be addressed to eliminate viral hepatitis in the United States.
The Plan provides a roadmap to integrate prevention, screening, and linkage to care for all components of the syndemic, to meet people where they are with no wrong point of entry to health care and related systems.
The Viral Hepatitis Plan recognizes the importance of addressing social determinants of health to improve health outcomes for racial, ethnic, and sexual and gender minority populations. By working to establish policies and programs that positively influence social and economic conditions and by supporting changes in individual behavior, health can be improved and sustained, and disparities reduced.
Although viral hepatitis affects millions of Americans nationwide from all social, economic, and racial and ethnic groups, it disproportionately impacts certain populations and communities. Viral hepatitis prevention and treatment efforts can be more efficient and effective by identifying and focusing efforts on populations that bear a disproportionately higher burden of infection and disease, referred to in the Viral Hepatitis Plan as priority populations.
The Plan uses nationwide surveillance data to determine the priority populations. Focusing on the priority populations will reduce health disparities and put the nation on the path toward elimination of viral hepatitis. This approach should not diminish efforts to increase awareness, prevention, treatment, and integration of viral hepatitis efforts more generally, for all populations. Stakeholders are encouraged to analyze the data for the populations and communities they serve to determine their priority populations.
National incidence, prevalence, and mortality rates were used to identify a small number of groups most impacted by each type of viral hepatitis .
Priority Populations by Hepatitis Type and Measure
|Type||Incidence (Acute)||Prevalence (Chronic)||Mortality|
Other Key Elements of the Viral Hepatitis Plan
The Viral Hepatitis Plan:
- Aims to increase uptake of hepatitis vaccination among populations for whom vaccination is recommended, increase access to harm reduction services, substance use treatment and peer navigation and utilize a treatment as prevention approach
- Seeks to implement universal hepatitis C screening guidelines, hepatitis B testing, and linkage to care in a range of settings and expand the capacity of the public health and provider workforce to provide viral hepatitis prevention, testing, care and treatment services
- Seeks to implement strategies and promote policies to enhance collaborative, integrated, patient-centered models of care
- Focuses on opportunities to expand research and development of a hepatitis C vaccine, point of care testing and improved diagnostics and therapeutics. The Plan also focuses on implementation research to put into practice evidence-based interventions, as effective interventions to improve prevention. testing and treatment are identified
- Aims to improve viral hepatitis surveillance data collection, management, and analysis, including interoperability of data and data sharing, to understand the true scope, level of public health threat, and opportunities to address viral hepatitis
The Viral Hepatitis Plan establishes indicators, as well as baseline measures and quantitative targets, to help measure progress toward the Plan’s goals. Eight core indicators will be used to measure progress on preventing new infections and improving viral hepatitis–related health outcomes of people with viral hepatitis. Five of the core indicators are stratified by one or more of the priority populations to measure progress toward reducing disparities.
The plan recommends the development of five additional indicators, referred to as developmental indicators. Data for these developmental indicators are not currently collected and doing so would fill critical gaps in measuring the nation’s efforts to eliminate the viral hepatitis epidemic.
Although focused on the years 2021–2025, the Viral Hepatitis Plan includes annual targets through 2030 because it will take more than 5 years to eliminate viral hepatitis as a public health threat in this nation. Establishing 2030 targets aligns with other national plans such as Healthy People 2030, the HIV National Strategic Plan: A Roadmap to End the Epidemic 2021-2025, the STI National Strategic Plan 2021-2025, and global targets established by the World Health Organization (WHO).
What’s Next: Implementation and Accountability
In 2021, federal partners will collaborate to develop an Implementation Plan which will set forth federal partners’ commitments to policies, initiatives, and activities to meet the goals and objectives of the Viral Hepatitis Plan. The Implementation Plan will be published for transparency and accountability.
Federal agency partners have committed to serve on a viral hepatitis implementation working group. This working group will meet regularly to coordinate activities across agencies and departments, including with other components of the syndemic, implement lessons learned from epidemiological data and research findings, monitor progress toward the indicator targets, course correct as needed, and report on national progress.
Stakeholders are encouraged to use the Viral Hepatitis Plan to build their own roadmap to reduce viral hepatitis and viral hepatitis-related health disparities and inequities, and to eliminate the viral hepatitis epidemics among the populations and communities they serve.
Stakeholders should consider adopting the vision and goals of the Viral Hepatitis Plan, examining challenges from a health equity lens, implementing the objectives and strategies relevant to their role, population(s), and community(ies), applying other evidence-based objectives and strategies, using available data to identify where their resources will have the most impact, and identifying indicators and targets to measure their progress.