The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy.

BACKGROUND: Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications. In response to the global outcry of hepatitis epidemic and the need to improve the nation's public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means. DISCUSSION: This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016. The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.

Avaliação das capacidades de detecção, avaliação e notificação das potenciais emergências em saúde pública de importância nacional e internacional pelo Centro de Informações Estratégicas em Vigilância em Saúde, Ministério da Saúde, Brasil / Assessment of the capabilities of detection, evaluation and reporting of potential public health emergencies of national and international importance by the Center for Strategic Information in Health Surveillance, Ministry of Health, Brazil

O Regulamento Sanitário Internacional – RSI (2005) é o instrumento jurídico internacional elaborado com a finalidade de proteção dos países quanto à disseminação internacional de doenças e articulação frente às emergências em saúde pública causadas por agentes biológicos, substâncias químicas, materiais radioativos e alimentos contaminados. Para tais finalidades, o RSI (2005) orienta o estabelecimento de Pontos Focais Nacionais nos Estados Partes, permanentemente acessíveis para comunicação direta com os Pontos de Contato da Organização Mundial da Saúde (OMS). Dentre as exigências de capacidades básicas segundo o RSI (2005), encontram-se as atividades de vigilância, informes e notificação. O Centro de Informações Estratégicas em Vigilância em Saúde da Secretaria de Vigilância em Saúde (SVS) do Ministério da Saúde (MS) – CIEVS/MS foi institucionalizado no contexto do RSI (2005) como estratégia de vigilância das emergências em saúde pública, a fim de desenvolver os processos de detecção, avaliação e notificação das potenciais emergências em saúde pública de importância nacional e internacional, na representação do Ponto Focal Nacional do Brasil para o RSI (2005). O objetivo geral deste estudo foi avaliar as capacidades de detecção, avaliação e notificação das potenciais emergências em saúde pública de importância nacional e internacional pelo CIEVS/MS no período de janeiro a dezembro de 2012. O método proposto foi a pesquisa avaliativa com a utilização do modelo lógico, segundo o qual foram estruturados os indicadores para avaliar o processo de trabalho do CIEVS/MS, considerando os aspectos político, técnico e organizacional, nos componentes de detecção, avaliação e notificação.

A classificação final das capacidades de detecção, avaliação e notificação das emergências em saúde pública pelo CIEVS/MS foi parcialmente adequada, correspondendo à distribuição de 50 por cento a 70 por cento de indicadores classificados como Bom nas três dimensões estratégicas e nos três componentes do processo de trabalho. No entanto, o componente notificação e a dimensão técnica mantiveram capacidade insuficiente. O estudo possibilitou identificar as potencialidades e as fragilidades do processo de trabalho do CIEVS/MS, além de propor a sistematização das rotinas e das atividades. Dentre as recomendações da pesquisa, destacam-se o aprimoramento do registro das informações, a documentação técnica do CIEVS/MS e a divulgação dos resultados do estudo aos dirigentes da SVS responsáveis pela definição das ações desenvolvidas pelo CIEVS/MS.

The International Health Regulations – IHR (2005) is the legal instrument with the purpose to protect countries against the international spread of disease and to provide the cooperation between Member States to prevent public health emergencies due to biological agents, chemical substances, radiological materials and contaminated food. In accordance with the IHR (2005), each State Party shall establish a National IHR Focal Point, which shall be accessible at all times for communications with the World Health Organization (WHO) IHR Contact Points. According to IHR (2005), State Parties are designated to develop certain minimum core public health capacities such as surveillance, reporting and notification. The Strategic Information Center for Health Surveillance from the Secretariat of Health Surveillance, Ministry of Health (CIEVS/MS, acronym in Portuguese) was institutionalized in the context of IHR (2005) as the strategy for surveillance of public health emergencies, with the objective to ensure detection, assessment and notification of events that may constitute public health emergencies of national and international concern, representing the National IHR Focal Point of Brazil. The main purpose of this study was to evaluate CIEVS/MS capacities for detection, assessment and notification of potential public health emergencies of national and international concern between January and December 2012. The proposed method was the evaluation research using the logic model, whereby the indicators were formulated to evaluate CIEVS/MS work process, according to political, technical and institutional aspects in detection, assessment and notification components.

The capacities for detection, assessment and notification were classified as partially appropriate, corresponding to the distribution of 50 per cent to 70 per cent of indicators rated as Good in the three strategic dimensions and the three components of the work process. However, the technical dimension and the notification component remained insufficient capacity. The study identified the strengths and weaknesses of CIEVS/MS work process, besides proposing routines and activities systematization. Among the recommendations, there are mainly the improvements of information recording, technical documentation of CIEVS/MS work process and dissemination of study results to the government leaders responsible for decision making to define the activities executed by CIEVS/MS.