The hepatitis C virus in Iran: health policy, historical, ethical issues and future challenges

The Sero-Prevalence of Hepatitis B and C Viruses in Municipal Waste Collectors in Southwest of Iran

Aims

The present study aimed to investigate the frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) serological markers among waste collectors in the municipality of Shiraz city, southwest of Iran, 2018.

Settings and Design

In this cross-sectional study, a total of 385 waste collectors from all 10 districts of Shiraz city, southwest of Iran were enrolled. A questionnaire was used to gather occupational and demographic information as well as awareness about viral hepatitis.

Methods and Material

Their blood samples were collected, and the sera were investigated for the presence of hepatitis B surface antigen (HBsAg), anti-HBs antibody, and anti-HCV antibody using enzyme-linked immunosorbent assay (ELISA).

Results

All the participants were men with a mean age of 41 ± 8 years. Out of 385 participants, 6 (1.5%) subjects were positive for HBsAg, indicative of HBV infection. Moreover, 38 (9.9%) had a protective level of anti-HBs antibodies, while more than 90% had a low level of anti-HBs antibodies. All participants were negative for HCV antibodies.

Conclusion

According to these findings, evaluation of HBsAg and anti-HBs levels is recommended in the healthy program of waste collector workers (WCWs). However, this occupation might not be a risk factor for the acquisition of HBV and especially HCV infections.

Hepatitis B vaccination in Iran: Historical policies and programs

Hepatitis B virus (HBV) infection is a main challenge of the health system worldwide. Health policymakers in most countries attempt to help HBV patients by implementing support programs in addition to controlling HBV in their community so that the economic burden caused by HBV do not deprive the patients of accessing health services and reducing their quality of life. There are several health interventions for the prevention and control of HBV. Providing the first dose of the HBV vaccine within 24 hours after the infant is born is the most cost-effective way to prevent and control HBV. The purpose of this study is to review the nature of HBV, its epidemiology in Iran and worldwide, and to review the various policies and programs in Iran regarding the prevention and control of HBV, especially the use of vaccination. One of the goals of Sustainable Development Goals (SDGs) is to consider hepatitis as a threat to human health. In this regard, one of the top priorities of WHO is the prevention and control of HBV. In connection with the prevention of HBV, it is claimed that vaccination is the most effective and best intervention. Thus, vaccination in the safe's program of countries is highly recommended. According to the Ministry of Health and Medical Education (MOHME) reports, Iran has the lowest prevalence of HBV among the countries in Eastern Mediterranean Region Organization (EMRO). There is a hepatitis unit in MOHME whose responsibility is to coordinate and implement the hepatitis prevention and control programs. The HBV vaccine has been officially included in the vaccination program for children in Iran since 1993, and three doses of the vaccine are given to all infants. In 2007, during a large-scale program in Iran, 17-year-olds received the HBV vaccine, followed by adolescents born in 1990 and 1991. In recent years, the health system in Iran has made significant progress in preventing and controlling HBV. Over 95% coverage of the HBV vaccination is one of the achievements that have had a great impact on reducing the trend of HBV infection. In order to achieve the 2030 goals, the Iranian government, in addition to paying more attention to HBV elimination programs, should encourage other organizations to cooperate more effectively with MOHME.

Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review

Background

Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization.

Methods

To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used.

Results

We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making.

Discussion

Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.

Ethical Considerations of Treating Patients Infected with Hepatitis C Virus

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