Global policy and access to new hepatitis C therapies for people who inject drugs

Abstract

People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV). This review outlines policy recommendations made in the 2014 World Health Organisation (WHO) Guidelines on Screening, Care and Treatment of HCV and their relevance to PWID. It also canvasses issues that will affect translation of these global guidelines into practice. The first global HCV guidelines released by WHO have recently advocated targeted HCV testing for PWID, assessment of liver disease and support for alcohol reduction during care. They also strongly advocate treatment using currently licensed direct-acting antiviral agents for all individuals, in particular PWID as a key affected population. New HCV treatment regimens have the potential to cure more than 90% of treated individuals. Scaling-up treatment among PWID has the potential to improve individual and population health by reducing HCV transmission, improving quality of life and supporting behaviour modifications that lead to less risk-taking over time. PWID face several barriers to accessing HCV care and treatment that need to be overcome. Testing services need re-orientation toward PWID, individuals need to be informed of their results and provided with direct linkage to ongoing care. Health services need to provide care in the community using simpler, cheaper and more accessible modes of delivery. Healthcare costs and pharmaceutical costs need to be minimised so PWID, who are highly marginalised, can access HCV treatment. Sustained scale-up of treatment for PWID could simultaneously improve individual health and achieve the goal of eliminating HCV transmission among this high-risk and vulnerable group.

Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost‐effectiveness analysis

“…13,14 Furthermore, effective treatment of PWID can lead to a reduction in the transmission of HCV to other drug users and the general population. 15 Addressing HCV infection amongst PWID must be a priority for the overall reduction in the HCV burden, 16 in order to meet the World Health Organization's (WHO) aim of elimination by 2030. 17…”

“…Therapeutic advances such as direct‐acting antivirals (DAAs), which have shorter treatment durations and higher cure rates than interferon‐based treatment regimens, offer the potential to improve the health outcomes of HCV‐positive PWID through increased treatment uptake . Furthermore, effective treatment of PWID can lead to a reduction in the transmission of HCV to other drug users and the general population . Addressing HCV infection amongst PWID must be a priority for the overall reduction in the HCV burden, in order to meet the World Health Organization's (WHO) aim of elimination by 2030…”

Alcohol Use Disorder and Hepatitis C Prevention and Care in People Who Inject Drugs: The State of Play

“…57 Expanding access to HCV treatment even among marginalized PWID will have both public health and social benefits. 9,58 Engaging primary care providers/general practitioners in the screening, follow-up, and treatment of HCV infection can extend access to HCV care. 59 The coordination of primary health care with addiction and HCV specialists is important to both engage and retain patients with AUD in HCV care.…”

Managing expense and expectation in a treatment revolution: Problematizing prioritisation through an exploration of hepatitis C treatment ‘benefit’

“…Consequently, widespread enthusiasm for the DAA "pharmacological revolution" is tempered with debate about fiscal management and rationing modalities (Doyle et al, 2015;Hickman et al, 2016;Martin et al, 2016).…”

“…The second: scale up and prioritise DAA treatment for 4 people who inject drugs (PWID), thus reducing incident infections and population prevalence Martin et al, 2016). The two visions are not mutually exclusive and are often conceptualised as a step-wise process, with health systems ideally encompassing both aims (Doyle et al, 2015(Doyle et al, : 1068.…”