Data: importance of monitoring and evaluation in the strategy development for the elimination of hepatitis
To achieve hepatitis elimination in the prison setting strategic information is needed to identify challenges and facilitate implementation of tailored and effective services, as well as monitor progress towards elimination targets (see box 1). Elimination targets for hepatitis in prisons should be locally developed. As an example, one country has defined these as key targets for monitoring (Mongale E, 2024; Bah R, 2024):
- >95% tested in last 12 months
- >90% of positives treated (and treatment commenced)
- Process in place for quarterly review of uptake, reception testing and need for assertive outreach
At international level the WHO Regional Office for Europe published the “Action plan for the health sector response to viral hepatitis in the WHO European Region” in 2017 to adapt the Global health Sector Strategy on viral Hepatitis 2016 – 2021 and to guide elimination efforts in Europe (WHO, 2017).
WHO has subsequently published consolidated guidelines on hepatitis strategic information that summarises the approach proposed by WHO to collect, analyse report and disseminate and use strategic information on viral hepatitis (WHO, 2024) (WHO, 2023).
These guidelines recommend a stepwise approach to building health information systems needed to help strengthen the scale up of viral hepatitis programmes.
ECDC subsequently established a monitoring system for hepatitis B and C in the EU and EEA in 2017 to support countries in assessing their responses to these epidemics and to assist in the assessment of progress towards the WHO elimination targets.
The EUDA is supporting the monitoring of elimination targets among the key population of people who inject drugs. The monitoring of responses to hepatitis aims to assess progress in scaling up key interventions and highlight any gaps in data to enable a more effective implementation of public health measures.
However, the monitoring of progress is challenged by both the complexity of the epidemiology and a lack of robust data with few countries in the EU/EEA able to provide complete, recent, and robust data along the continuum of care with a particular lack of data relating to specific key populations including people in prison.
EUDA has also established a monitoring framework on drugs in prisons, identifying key data collection tools and indicators to be collected in prisons in order to monitor the situation and interventions in prison settings to address drug-related problems among prison populations, including for drug-related diseases and for hepatitis in particular. Furthermore, EUDA’s key epidemiological indicators on drug-related infectious diseases also include data collection on hepatitis in prison settings.
All these elements can be useful to put in place a well-functioning health information system to generate timely data to monitor the health status of the prison population and evaluate the performance of the prison health system (WHO 2021).
The establishment of a strong health information system inside the prison (allowing information to be shared with health systems in the community) that includes infectious diseases, is critical in the prisons as explained above (see Section 1).