Blue-Print for Elimination of Hepatitis C Viral Infection: One Step Closer
Kevork M. Peltekian
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Division of Digestive Care & Endoscopy, Queen Elizabeth II Health Sciences Centre. Departments of Medicine and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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array:23 [ "pii" => "S1665268119304259" "issn" => "16652681" "doi" => "10.5604/01.3001.0010.2703" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "70247" "copyright" => "Fundación Clínica Médica Sur, A.C." "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Ann Hepatol. 2017;16:696-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 89 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 41 "PDF" => 36 ] ] "itemSiguiente" => array:19 [ "pii" => "S1665268119304260" "issn" => "16652681" "doi" => "10.5604/01.3001.0010.2706" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "70248" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Ann Hepatol. 2017;16:699-701" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 68 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 26 "PDF" => 35 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Waiting-Time and Quality of Care Deserved to Patients with Early Stage Hepatocellular Carcinoma Undergoing RFA Treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "699" "paginaFinal" => "701" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maurizio Soresi, Anna Licata, Lydia Giannitrapani, Giuseppe Montalto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maurizio" "apellidos" => "Soresi" ] 1 => array:2 [ "nombre" => "Anna" "apellidos" => "Licata" ] 2 => array:2 [ "nombre" => "Lydia" "apellidos" => "Giannitrapani" ] 3 => array:2 [ "nombre" => "Giuseppe" "apellidos" => "Montalto" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304260?idApp=UINPBA00004N" "url" => "/16652681/0000001600000005/v1_201905301208/S1665268119304260/v1_201905301208/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Blue-Print for Elimination of Hepatitis C Viral Infection: One Step Closer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "696" "paginaFinal" => "698" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Kevork M. Peltekian" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Kevork M." "apellidos" => "Peltekian" "email" => array:1 [ 0 => "kevork.peltekian@nshealth.ca" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Digestive Care & Endoscopy, Queen Elizabeth II Health Sciences Centre. Departments of Medicine and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprints request:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0010" class="elsevierStylePara elsevierViewall">Back in March 1997, an international workshop was held in Dahlem, Germany, focusing on principles for eradication of infectious diseases.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> During the workshop the hierarchy of possible public health interventions for dealing with infectious diseases were described and defined (<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>). All these interventions need three important prerequisites:<ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="o0010"><span class="elsevierStyleLabel">a)</span><p id="p0015" class="elsevierStylePara elsevierViewall">Effective intervention to interrupt transmission of the infectious agent;</p></li><li class="elsevierStyleListItem" id="o0015"><span class="elsevierStyleLabel">b)</span><p id="p0020" class="elsevierStylePara elsevierViewall">Practical diagnostic tools with sufficient sensitivity and specificity to detect levels of infection that can lead to transmission; and</p></li><li class="elsevierStyleListItem" id="o0020"><span class="elsevierStyleLabel">c)</span><p id="p0025" class="elsevierStylePara elsevierViewall">Humans being essential for the life cycle of the infectious agent.</p></li></ul></p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0030" class="elsevierStylePara elsevierViewall">At that same meeting, it was recognized that health resources are generally limited. Hence decisions had to be made early whether one would use elimination or eradication programs. The costs and benefits of global eradication programmes had to be measured with their direct effects on morbidity and mortality and eventually on the health care system. The participants of the Dahlem Workshop also recognized that success depended strongly on the level of societal and political commitment, with a key role for the World Health Assembly.</p><p id="p0035" class="elsevierStylePara elsevierViewall">In 2016, twenty-seven years after the hepatitis C virus (HCV) was discovered, 194 member countries of the World Health Organization (WHO) adopted the first global health sector strategy on viral hepatitis to halt transmission of viral hepatitis and provide everyone living with viral hepatitis access to safe, affordable, and effective care and treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> WHO published its advocacy brief for combating viral hepatitis to reach elimination by the year 2030. <a class="elsevierStyleCrossRef" href="#t0015">Table 2</a> provides summary of interventions and targets specific for HCV.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> Subsequently, all four leading professional organizations in liver disease endorsed elimination of viral hepatitis urging governments, healthcare organizations and non-governmental organizations to implement action plans to move this process forward.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0040" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Annals of Hepatology</span>, Francheville, <span class="elsevierStyleItalic">et al</span>. describe their experience from the first 12 months of multi-phase hepatitis C elimination strategy within the geographic confines of Prince Edward Island (PEI), the smallest of Canadian provinces. They demonstrate encouraging results for improved access to treatment, enhanced engagement by health care providers, and increased rates of cure for patients living with chronic hepatitis C genotype-1.</p><p id="p0045" class="elsevierStylePara elsevierViewall">Prince Edward Island population is approximately 146,000. It is estimated there are 629 individuals infected with HCV on the Island. The current study reports the initial 242 referrals (comprising 38% of all HCV cases living in PEI), 123 patients (50% of referred) seen for intake assessments, and 93 (76% of assessed) started on direct-acting antiviral (DAA) therapy based on medical need. All of this occurred in the first year of the Program. Furthermore, sustained viral response was documented in more than 95% of subjects who completed treatment with DAAs.</p><p id="p0050" class="elsevierStylePara elsevierViewall">The availability of DAAs for HCV provides opportunities to eliminate HCV but the latter also requires scaling-up of treatment with considerable cost. Bringing local health care providers, government, industry, and HCV community groups together created a province-wide model of care. This collaboration might have been the most important aspect of the Program. In spite high prices, PEI announced the decision to provide treatment for all persons infected with HCV. As a result of a collaborative procurement strategy between Government and industry, treatment regime with DAAs was provided to all eligible patients – a feat previously thought impossible. Any public health expert in infectious disease eradication or elimination will emphasize the need for societal and political commitment. The political commitment for elimination strategy goes hand-in-hand with appropriate advocacy. This article provides proof-of-principle for starting elimination program for HCV within a specific geographic area. The real success of the Program will be clearer with long-term monitoring.</p><p id="p0060" class="elsevierStylePara elsevierViewall">As different jurisdictions start their individual HCV elimination strategies, new post-elimination challenges will arise. If PEI became HCV-negative jurisdiction, how would they enforce zero incidence for HCV? Will they require point-of-care testing at entry points to the Island? Will they be able to identify each asymptomatic carrier of HCV who may potentially transmit the virus and re-introduce HCV to the Island? Would there be viable vaccination programs for people who inject drugs? Or will the post-elimination strategy depend on post-exposure prophylaxis protocol for those potentially exposed to HCV? Even if HCV is eliminated from any jurisdiction, there will be global demand for further research into these questions and other medical or public health challenges.</p><p id="p0065" class="elsevierStylePara elsevierViewall">Elimination programs for HCV are laudable, but carry awesome responsibility. Unlike eradication programs, elimination programs can handle some failure. Careful and deliberate evaluation of every program is a prerequisite to navigate the best strategies for elimination of HCV - the ultimate goal of public health. This article provides a blue-print.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-01" "fechaAceptado" => "2017-08-01" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level following deliberate efforts with ongoing intervention measures to maintain this reduction. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elimination of disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduction to zero the incidence of a specific disease in a defined geographical area as a result of deliberate efforts with ongoing intervention measures. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elimination of infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduction to zero the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts with continued measures to prevent re-establishment of transmission. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eradication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Permanent reduction to zero of the worldwide incidence of infection caused by the specific agent as a result of deliberate efforts. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extinction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The specific infectious agent no longer exists in nature or in the laboratory. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2045085.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Definition of Public Health Interventions for Infectious Diseases.</p>" ] ] 1 => array:7 [ "identificador" => "t0015" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Target Area \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline 2015 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020 target \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2030 target \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Service coverage</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prevention Blood safety: donations screened with quality assurance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Injection safety: use of engineered devices \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Harm reduction (sterile syringe/needle set distributed per person per year for people who inject drugs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">300 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TreatmentDiagnosis of HCV (coverage %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment of HCV (coverage %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 million \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80% eligible treated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Impact leading to elimination</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Incidence of chronic HCV infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5-10 million \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30% reduction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% reduction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality from chronic HCV infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.70 million \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10% reduction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65% reduction \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2045084.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">WHO Targets for Elimination of HCV from 2015-2030 (adapted from reference 3).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Dowdle W.R." 1 => "Hopkins D.R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "The eradication of infectious diseases: report of the Dahlem Workshop on the Eradication of Infectious Diseases" "serieFecha" => "1998" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0015" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global health sector strategy on viral hepatitis 2016-2021: towards ending viral hepatitis. Geneva, Switzerland: World Health Organization; 2016" ] ] ] 2 => array:3 [ "identificador" => "bib0020" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Combating hepatitis B and C to reach elimination by 2030: advocacy brief. Geneva, Switzerland: World Health Organization; 2016" ] ] ] 3 => array:3 [ "identificador" => "bib0025" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint society statement for elimination of viral hepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Brahm J." 1 => "Castera L." 2 => "Hou J." 3 => "Lindor K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5604/16652681.1226808" "Revista" => array:7 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2017" "volumen" => "16" "numero" => "1" "paginaInicial" => "6" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28051786" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001600000005/v1_201905301208/S1665268119304259/v1_201905301208/en/main.assets" "Apartado" => array:4 [ "identificador" => "77716" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001600000005/v1_201905301208/S1665268119304259/v1_201905301208/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304259?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 10 | 13 | 23 |
| 2024 September | 10 | 5 | 15 |
| 2024 August | 8 | 3 | 11 |
| 2024 July | 7 | 2 | 9 |
| 2024 June | 5 | 14 | 19 |
| 2024 May | 5 | 3 | 8 |
| 2024 April | 9 | 4 | 13 |
| 2024 March | 21 | 8 | 29 |
| 2024 February | 6 | 10 | 16 |
| 2024 January | 7 | 8 | 15 |
| 2023 December | 5 | 5 | 10 |
| 2023 November | 5 | 3 | 8 |
| 2023 October | 11 | 10 | 21 |
| 2023 September | 6 | 2 | 8 |
| 2023 August | 11 | 5 | 16 |
| 2023 July | 7 | 5 | 12 |
| 2023 June | 10 | 5 | 15 |
| 2023 May | 33 | 10 | 43 |
| 2023 April | 35 | 6 | 41 |
| 2023 March | 16 | 7 | 23 |
| 2023 February | 15 | 1 | 16 |
| 2023 January | 4 | 19 | 23 |
| 2022 December | 8 | 26 | 34 |
| 2022 November | 9 | 14 | 23 |
| 2022 October | 9 | 8 | 17 |
| 2022 September | 6 | 8 | 14 |
| 2022 August | 9 | 4 | 13 |
| 2022 July | 11 | 7 | 18 |
| 2022 June | 8 | 10 | 18 |
| 2022 May | 6 | 6 | 12 |
| 2022 April | 4 | 6 | 10 |
| 2022 March | 7 | 14 | 21 |
| 2022 February | 5 | 3 | 8 |
| 2022 January | 13 | 3 | 16 |
| 2021 December | 4 | 10 | 14 |
| 2021 November | 8 | 4 | 12 |
| 2021 October | 30 | 13 | 43 |
| 2021 September | 30 | 8 | 38 |
| 2021 August | 6 | 4 | 10 |
| 2021 July | 4 | 10 | 14 |
| 2021 June | 9 | 7 | 16 |
| 2021 May | 8 | 10 | 18 |
| 2021 April | 12 | 14 | 26 |
| 2021 March | 7 | 2 | 9 |
| 2021 February | 4 | 6 | 10 |
| 2021 January | 3 | 8 | 11 |
| 2020 December | 4 | 4 | 8 |
| 2020 November | 7 | 3 | 10 |
| 2020 October | 12 | 5 | 17 |
| 2020 September | 8 | 7 | 15 |
| 2020 August | 5 | 5 | 10 |
| 2020 July | 7 | 8 | 15 |
| 2020 June | 1 | 1 | 2 |
| 2020 May | 5 | 4 | 9 |
| 2020 April | 4 | 3 | 7 |
| 2020 March | 1 | 1 | 2 |
| 2020 February | 6 | 2 | 8 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 5 | 7 | 12 |
| 2019 November | 3 | 1 | 4 |
| 2019 October | 4 | 1 | 5 |
| 2019 September | 3 | 3 | 6 |
| 2019 August | 1 | 1 | 2 |
| 2019 July | 7 | 12 | 19 |
| 2019 June | 9 | 3 | 12 |
| 2019 May | 2 | 5 | 7 |
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