As the burden of hepatitis is increasing in the country, necessitating focus on prevention and control measures to mitigate the morbidity and mortality, the Indian Council of Medical Research (ICMR) will soon begin research on 'Viral hepatitis in India'.
The priority areas of research included lab monitoring/strengthening for real time data inflow and feedback for automated report generation using modern technology; and rapid or molecular technology utilization for capacity building and hands-on training of laboratory staff at various levels to perform molecular assays and use of molecular technology in understanding the distribution/clustering of strains/circulating genotypes/serotypes.
In the operational research, the research will focus on disease burden studies (epidemiology, transmission dynamics and risk factors) for viral hepatitis with special focus on HEV; to understand viral/host components leading to severity during pregnancy for Hepatitis E; identify barriers for low immunization coverage for Hep B in India; studies to understand the impact of immunization of Hep B over years; develop point-of-care diagnostics (for bedside use) with good sensitivity and specificity; multi-centric screening of blood and stool samples from organ transplant patients to know HEV chronicity; field testing / clinical trials of new interventions (drugs/vaccines); to analyse HBV vaccine response in HIV infected individuals; comparison of indigenous and Chinese HEV vaccines in clinical trials; understanding efficacy of alternative medicine in preventing/treating viral hepatitis; assessment of utility and cost effectiveness studies of NAT with routine ELISA in blood banks in HBV, HCV and HIV among blood donors; estimating the cost-effectiveness of RUP syringes; and understanding modes of transmission of viral hepatitis B in local settings.
In the area of prevention, the focus will be on to assess re-infection rates in Hep B and Hep C; to assess SVR in re-infection rates; to develop interventions to prevent re-infections; develop monitoring systems for adherence to DAAs; studies to identify effective approaches for partner testing; to identify effective approaches for adherence to treatment in different risk groups; and to assess incidence of hepatitis A among men having sex with men.
The ICMR's initiative is significant as viral hepatitis is increasingly being recognized as a public health problem, having epidemic proportions that cause 1.34 million deaths each year. In India, the estimated burden of hepatitis is very high, necessitating focus on prevention and control measures of hepatitis to mitigate the morbidity and mortality due to hepatitis. Amongst the reported causes of mortality amongst communicable diseases in India in 2015, viral hepatitis accounted for 3% of total. There is however, a paucity of nationally representative data to establish accurate disease burden. New infections caused by the five known hepatitis viruses – A, B, C, D and E (HAV, HBV, HCV, HDV and HEV) – can be prevented. In addition, testing and treatment can improve the health of persons with chronic infections. The sequel to chronic hepatitis includes cirrhosis and hepato-cellular carcinoma that pose long term burden on the health system.
India is committed to achieve the SDGs and the SDG 3.1 aims to achieve the elimination of viral hepatitis by 2030. The Government of India is a signatory to this WHA resolution and the country’s vision is to move towards elimination of Viral Hepatitis by 2030. With this background, a comprehensive integrated 3 year National Action Plan for Viral Hepatitis (NAPVH) is being developed by MoH&FW, Govt. of India, with the key objective to provide an actionable framework of evidence based, priority interventions to support the national response for prevention, control and management of viral hepatitis in the country.
In view of the above and existing gaps in current programmes, it is pertinent to address all aspects under the Integrated National Programme on Prevention and Control Programme for Viral hepatitis, of which research and innovation is one important component. It is proposed to enhance knowledge and skills required for evidence base on various aspects of the epidemic, up-scaled operational research, cross-cutting, multi-disciplinary themes, improved research quality, better research capabilities and expanded partnerships, utilization and management of research based knowledge on viral hepatitis, relevant measurable and context specific indicators for tracking the epidemic and assessing impact. The program will focus more on operational programmatic research that could feed into planning and policy decision.
The research proposals can be submitted by January 15, 2018.