Protocol to estimate mortality from cirrhosis and hepatocellular carcinoma attributable to viral hepatitis B and C

One of the goals to be achieved by 2030 of the Global Health Sector Strategy on Viral Hepatitis 2016-2021 is to reduce mortality from hepatitis viruses B (HBV) and C (HCV). To measure and monitor it, countries need to implement a systematic process to generate national estimates of mortality from viral hepatitis, which many lack. This document is aimed at the institutions and/or ministries in charge of monitoring progress in each country.

The main objective of this protocol is to present simple methods to estimate the proportion of patients with cirrhosis and hepatocellular carcinoma who have HBV and HCV infection, and then calculate the national mortality due to these sequelae attributable to viral hepatitis, preferably within a surveillance system. In addition, a general framework is provided on how the surveillance system should function, how to collect the data, and ethical considerations.

The surveillance system will be based on sentinel centers where information will be collected from patients with cirrhosis and hepatocellular carcinoma. These data will be used to estimate the fraction of cirrhosis and hepatocellular carcinoma attributable to HBV and HCV. On the other hand, data will be collected on the number of deaths nationwide from cirrhosis and hepatocellular carcinoma. With this information, mortality from cirrhosis and hepatocellular carcinoma attributable to HBV and HCV will be estimated.