The hepatitis pandemic has had an increasingly negative impact on the lives of communities and health systems. Despite falling mortality from HIV/AIDS, tuberculosis and malaria, viral hepatitis account for 1.4 million deaths a year (a rise of 22% since 2000)[1]due to acute hepatitis and hepatitis-related diseases such as cirrhosis and liver cancer.
Hepatitis are currently a growing and significant cause of mortality in people living with Human Immunodeficiency Virus (HIV). Worldwide, about 2.9 million people living with HIV are co-infected with the Hepatitis C Virus (HCV) and 2.6 million with the Hepatitis B Virus (HBV).
Viral hepatitis B is transmitted essentially by blood and contaminated liquids. Its main mode of transmission, in a high prevalence context such as that in Mozambique, is vertical transmission.
Over 90% of new hepatitis B infections in Africa occur through transmission from mothers to their children and in early childhood. The high rate of HBV and HCV infection is also due mainly to unsafe blood transfusions, unsafe injections and social and traditional practices.
Although found throughout the world, hepatitis C is more prevalent in East Asia, North and West Africa. In these areas, most cases are the result of unsafe injections or other unsafe medical acts. Studies report that in some regions, around 67% of people who use drugs are infected with HCV – one of the highest transmission risk groups in the world.
Although there is little available information on viral hepatitis in Mozambique, the few studies on viral hepatitis, modelling results and the recent baseline assessment conducted under the joint review of the TB Strategic and Operational Plan, the HIV Response Strategic Plan, show a high prevalence of chronic viral hepatitis B (7.2% representing 2.1 million chronic infections and 3,000 new cases of liver cirrhosis and cancer each year) and C. There are also high levels of mortality due to liver disease and liver cancer (HBV associated with liver cancer is the third most common cause in men) associated with limited diagnostic and treatment capacity. This situation will tend to get worse if the current level of interventions is maintained. The third Sustainable Development Goal (SDG) has 9 targets. Target 3.3 addresses ending, by 2030, the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, and fighting hepatitis.
In response to the SDGs, in 2016 the World Health Assembly endorsed the elimination of hepatitis as a public health threat by 2030 and published the first global strategy for the elimination of hepatitis by 2030, containing very clear interventions and targets. Eliminating viral hepatitis means reducing incidence by 90% and mortality by 65%. To this end, countries should develop specific plans, and WHO should produce annual progress reports.
The global HVB target for 2020 is to reduce incidence below 1% in children under 5 years of age. This ambitious target can only be achieved through vaccination, including a postpartum dose, and measured through bio-marker surveys that estimate the prevalence of HBV infection among children. Achievement of the 2020 target will then pave the way for the ambitious 2030 target of reducing the prevalence of HBV infection to 0.1%.
Given the recent WHO recommendations on the elimination of hepatitis by 2030, Mozambique’s Ministry of Health (Ministério da Saúde – MISAU) intends to hire an international consultant to prepare its first National Strategic Plan to address the hepatitis problem in the country.
To support Ministry of Health (MOH) to development the National Viral Hepatitis Strategic Plan 2019-2023 (Plano Estratégico Nacional das Hepatites Virais – PENHV 2019-2023)
The development of the Viral Hepatitis Strategic Plan and the respective operational plan must be based on a detailed and programmed work proposal that itemises the activities to be carried out.
The work methodology should include, among other actions:
The various documents to be consulted include, in particular, the following:
In MOH: the consultant will be expected to interview/consult senior officials in the following sectors: HIV program (PNC STI-HIV/SIDA), including the Prevention Mother to Child Transmission (PMTCT) Focal Point; Mental Health; Mother and Child Health (MCH); Expanded Programme of Immunisation (EPI); Central Laboratory Department (Departamento Central de Laboratórios – DCL); the Central Medicines and Medical Supplies Store (Central de Medicamentos e Artigos Médicos – CMAM); National Blood Service (Serviço Nacional de Sangue – SENASA); National Cancer Service; National Institute of Health (INS); Maputo Central Hospital (Gastroenterology service and central laboratory) and some Provincial Directorates of Health.
Other government services considered relevant (e.g. Education, Universities);
Partners such as the World Health Organisation (WHO); Medicus Sen Fronteir (MSF); among others.
Civil Society UNIDOS, The Foundation for Community Development (FDC), etc
Focus groups of clinicians (e.g. gastroenterologists in Maputo Central Hospital with experience of caring for and treating patients with hepatitis); civil society organisations, populations at risk, among others.
The technical assistance should:
6.3.1. Languages
6.3.2 . Computer
6.3 Skills:
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