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J Int AIDS Soc. 2017 Jul 28;20(1):22146. doi: 10.7448/IAS.20.1.22146.

Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there?

Author information

1
The Kirby Institute, UNSW Sydney, Sydney, Australia.
2
Executive Board, International Network on Hepatitis in Substance Users, Zurich, Switzerland.
3
HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland.
4
Department of Medicine I, University Hospital Bonn, Bonn, Germany.
5
Governing Council, International AIDS Society, Geneva, Switzerland.
6
Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.

Abstract

INTRODUCTION:

Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action.

DISCUSSION:

Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID.

CONCLUSIONS:

The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.

KEYWORDS:

HCV; HIV; NSP; OST; control; drug users; elimination; hepatitis C

PMID:
28782335
PMCID:
PMC5577699
DOI:
10.7448/IAS.20.1.22146
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

JG is a consultant/advisor and has received research grants from Abbvie, Cepheid, Bristol Myers Squibb, Gilead Sciences and Merck/MSD. GD is a consultant/advisor and has received research grants from Abbvie, Bristol Myers Squibb, Gilead, Merck, Janssen and Roche. JKR has received honoraria for consulting or speaking at educational events from Abbott, Abbvie, Bionor, BMS, Cipla, Gilead, Janssen, Merck and ViiV. MBK received research grants for investigator initiated trials from Merck and ViiV Healthcare; consulting fees from ViiV Healthcare, Bristol-Meyers Squibb, Merck, Gilead and AbbVie.

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