Send to

Choose Destination
Liver Int. 2019 Jan;39(1):20-30. doi: 10.1111/liv.13949. Epub 2018 Sep 22.

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework.

Author information

Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine, Sydney, New South Wales, Australia.
Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.
Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
CHUM Research Centre (CRCHUM), Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
Division of Global Public Health, University of California, San Diego, California.
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
Department of Infectious Diseases, Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway.
The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Australian Injecting & Illicit Drug Users League, Canberra, Australian Capital Territory, Australia.
University of South Carolina School of Medicine Greenville, Greenville, South Carolina.
Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Arud Centres for Addiction Medicine, Zürich, Switzerland.
Department of Gastroenterology, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
Philadelphia FIGHT, Philadelphia, Pennsylvania.
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.


The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C 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. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.


elimination; health systems; people who inject drugs; viral hepatitis C


Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center