Introduction and Objectives Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide. We aimed to explore HCC-related population-wide public health policies (PHP) worldwide. Materials and Methods We conducted a 43-item survey about HCC: policies and civil society (18 questions), clinical guidelines (5 questions), epidemiology (7 questions), and care management (13 questions). The survey was completed electronically (2022–2023). Data were collected in a spreadsheet, revised by two independent reviewers, and verified with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We classified policies into eight dimensions, including criteria for low, moderate, and strong PHP establishment. We estimated an index using multiple correspondence analysis. Results We obtained 134 responses from 66 countries/territories (Africa N=16, the Americas N=18, Asia N=10, Europe N=21, and Oceania N=1). The median index was 43.7 [IQR: 30.9–59.3]. The lower scores were observed in Sierra Leone (0), Lebanon (5.5), and Pakistan (5.5), while Italy (79.7), Brazil (94.1), and Sweden (100) obtained the highest scores (Figure). In particular, 46 (69.7%) countries had a written national cancer strategy or action plan, but only 5 (7.6%) had a specific written national strategy or action plan on HCC. Thirty-two (48.5%) countries had national clinical practice guidelines on HCC and 54 (81.8%) countries had a national disease registry that included HCC. The most common strategies for staging HCC were Barcelona Clinic Liver Cancer (BCLC)(85%) and TNM classification (10%). The survey reflects important differences in the availability of treatments, including surgery (98.4%), tyrosine kinase inhibitors (95.1%), chemoembolization (85.2%), radiofrequency or alcohol ablation (82%), immunotherapy plus anti-VEGF (82%), liver transplant (74.2%), stereotactic body radiation therapy (42.6%), and radioembolization (36.4%). Conclusions The existence of PHP on HCC is insufficient worldwide. The most common strategy for staging is BCLC, but there are important differences in treatment availability across countries, especially regarding curative therapies.

Introduction and Objectives Although the WHO strategy aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030, national strategies are variable worldwide. This study aimed to assess the establishment of different policies and strategies to eliminate HCV in the Americas. Materials and Methods We conducted a 23-item survey about HCV-related policies and strategies among gastroenterologists and hepatologists in the Americas. The survey was carried out electronically (2022–2023). Data were compared with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We estimated an index obtained from a regression scoring method through exploratory analysis, and row values were normalized from 0 to 100. Results We obtained 52 responses from 19 countries. The median HCV-related policies index was 51.4 [IQR:27.3–70.1]. The lower establishment of HCV-related policies was observed in Ecuador (0.0), Honduras (6.6), and Costa Rica (9.8), while the highest performance was observed in Argentina (94.1), Colombia (94.7), and Canada (100)(Figure 1A). Fifteen (78.9%) countries have adopted a national strategic plan to eliminate HCV. Three (15.8%) countries have universal screening for HCV infection (Figure 1B). After a positive HCV serological test, 10 (52.6%) countries perform reflex testing to confirm HCV diagnosis using the same sample. However, only 7 (36.8%) countries have an alert system for the requesting physician. Twelve (63.2%) countries have a direct referral system for specialized care of HCV-positive cases. Universal access to direct-acting antivirals (DAAs) exists in 15 (78.9%) countries. Universal access to DAAs was not widely available in Cuba, Ecuador, Venezuela, and the United States. Seven (36.8%) countries have generic DAAs available. Only 3 (15.8%) countries performed a retrospective search for HCV-positive cases that could have been lost to follow-up. Conclusions Although most countries have adopted a national strategic plan to eliminate HCV, there are several issues and barriers to elimination in the Americas.

Liver transplantation (LT) is a cost-effective therapy for advanced liver disease. Although LT significantly improves long-term survival, it requires strict control of immunosuppressants and their potential complications. Several available immunosuppressive drugs include glucocorticoids, calcineurin inhibitors, mycophenolate, mTOR inhibitors, and anti-CD25 antibodies. These drugs act particularly in T lymphocytes, depleting them, deviating their traffic, or blocking their response pathways. The main complications after LT include renal failure and infectious, immunological, biliary, vascular adverse events, metabolic, cardiovascular, and neoplastic diseases, especially during the first months. Bacteria, viruses, and fungi can cause infections in these patients. Prophylaxis against Herpes simplex virus, Varicella zoster virus, Cytomegalovirus, Pneumocystis jirovecii, Candida spp., and Aspergillus spp. should be considered according to the presence of risk factors. Among immunological complications, acute cellular rejection is common (30% of LT) but usually responds to immunosuppressive escalation. Also, chronic rejection appears in 3-17% of LT, but only half of the recipients respond to increased immunosuppressants. Appropriate treatment of the underlying etiology is essential, especially in autoimmune diseases, hepatitis B and C virus infection. Lifestyle changes must be encouraged in all patients, and alcohol consumption avoided (especially in alcohol use disorder). Due to the increased risk of cancer, neoplasms must be actively monitored, as well as osteoporosis and other metabolic disorders such as diabetes and cardiovascular disease.

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide. We aimed to explore HCC-related population-wide public health policies (PHP) worldwide. We conducted a 43-item survey about HCC: policies and civil society (18 questions), clinical guidelines (5 questions), epidemiology (7 questions), and care management (13 questions). The survey was completed electronically (2022–2023). Data were collected in a spreadsheet, revised by two independent reviewers, and verified with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We classified policies into eight dimensions, including criteria for low, moderate, and strong PHP establishment. We estimated an index using multiple correspondence analysis. We obtained 134 responses from 66 countries/territories (Africa N=16, the Americas N=18, Asia N=10, Europe N=21, and Oceania N=1). The median index was 43.7 [IQR: 30.9–59.3]. The lower scores were observed in Sierra Leone (0), Lebanon (5.5), and Pakistan (5.5), while Italy (79.7), Brazil (94.1), and Sweden (100) obtained the highest scores (Figure). In particular, 46 (69.7%) countries had a written national cancer strategy or action plan, but only 5 (7.6%) had a specific written national strategy or action plan on HCC. Thirty-two (48.5%) countries had national clinical practice guidelines on HCC and 54 (81.8%) countries had a national disease registry that included HCC. The most common strategies for staging HCC were Barcelona Clinic Liver Cancer (BCLC)(85%) and TNM classification (10%). The survey reflects important differences in the availability of treatments, including surgery (98.4%), tyrosine kinase inhibitors (95.1%), chemoembolization (85.2%), radiofrequency or alcohol ablation (82%), immunotherapy plus anti-VEGF (82%), liver transplant (74.2%), stereotactic body radiation therapy (42.6%), and radioembolization (36.4%). The existence of PHP on HCC is insufficient worldwide. The most common strategy for staging is BCLC, but there are important differences in treatment availability across countries, especially regarding curative therapies.

Although the WHO strategy aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030, national strategies are variable worldwide. This study aimed to assess the establishment of different policies and strategies to eliminate HCV in the Americas. We conducted a 23-item survey about HCV-related policies and strategies among gastroenterologists and hepatologists in the Americas. The survey was carried out electronically (2022–2023). Data were compared with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We estimated an index obtained from a regression scoring method through exploratory analysis, and row values were normalized from 0 to 100. We obtained 52 responses from 19 countries. The median HCV-related policies index was 51.4 [IQR:27.3–70.1]. The lower establishment of HCV-related policies was observed in Ecuador (0.0), Honduras (6.6), and Costa Rica (9.8), while the highest performance was observed in Argentina (94.1), Colombia (94.7), and Canada (100)(Figure 1A). Fifteen (78.9%) countries have adopted a national strategic plan to eliminate HCV. Three (15.8%) countries have universal screening for HCV infection (Figure 1B). After a positive HCV serological test, 10 (52.6%) countries perform reflex testing to confirm HCV diagnosis using the same sample. However, only 7 (36.8%) countries have an alert system for the requesting physician. Twelve (63.2%) countries have a direct referral system for specialized care of HCV-positive cases. Universal access to direct-acting antivirals (DAAs) exists in 15 (78.9%) countries. Universal access to DAAs was not widely available in Cuba, Ecuador, Venezuela, and the United States. Seven (36.8%) countries have generic DAAs available. Only 3 (15.8%) countries performed a retrospective search for HCV-positive cases that could have been lost to follow-up. Although most countries have adopted a national strategic plan to eliminate HCV, there are several issues and barriers to elimination in the Americas.

Introduction and Objectives: Although most cases of HCC occur in patients with advanced liver disease and there are effective screening methods, health policies aimed at preventing and detecting HCC are not often on the agenda of government initiatives and policies. This study aimed to explore HCC-related population-wide public health policies, treatment availability, epidemiological surveillance, and awareness campaigns in the Americas. Materials and Methods: We conducted a 43-item survey about HCC among experts from 12 countries. Questions were classified into four categories: policies and civil society (18 questions), clinical guidelines (5 questions), epidemiology (7 questions), and care management (13 questions). The survey was administered using an electronic form in May 2022. Data was collected in a spreadsheet, revised by two independent reviewers, and contrasted with governmental institutions. Results: We obtained 22 responses from 15 out of the 18 countries targeted. A total of 7 (47%) countries had a written national cancer strategy or action plan. Only 4 (27%) countries had a specific written national HCC strategy or action plan, including Argentina, Brazil, Mexico, and the United States. These same four countries also had national clinical guidelines on HCC. HCC is managed by various providers, including Hepatologists (80%), Oncologists (80%), Gastroenterologists (60%), Surgeons (47%), and Palliative medicine (20%). There were important differences in the availability of treatments among countries in the Americas (Figure). Of note, 60% of countries had liver transplantation available for HCC, but only 67% of them had this therapy outside the capital city. Nine (60%) countries had a national disease registry that included HCC. However, only Brazil (7%) had governmental funded awareness campaigns on HCC prevention or screening. Conclusions: Implementation of public health policies on HCC is scarce in the Americas. Important differences in treatments were observed across countries, especially in curative therapies. Our results strongly encourage developing public health policies on HCC in the Americas.