New developments and opportunities for preventing hepatitis C virus (HCV) among people who use and inject drugs-announcing anAddictionseries

Abstract

We announce a new series for Addiction on HCV (hepatitis C virus). This is prompted by the changing treatment and prevention landscape and syndemic of HCV and drug use, specifically concerning people who inject drugs (PWID). In some developing countries more than 80% of HCV is among people with a history of drug injection; globally, almost 40% of HCV burden is attributable to injecting drug use and in many countries one in two PWID are likely to be living with HCV [1][2][3]. HCV is an important cause of liver disease, along with alcohol, hepatitis B virus (HBV) and metabolic causes, and the only one that can be cured easily [4]. There is no vaccine available for HCV. However, new HCV anti-viral drugs-so-called direct-acting anti-virals (DAAs)-are highly tolerable, of short duration (8-12 weeks) and can cure the disease in the vast majority of cases, with trials involving PWID reporting more than 90% cure rates [5][6][7].These advancements have raised excitement around the possibility of using HCV treatment as Prevention (TasP). Globally, however, very few PWID are treated for their HCV. Although the cost of DAA therapies can be high, health economic models suggest that prioritizing PWID for early HCV treatment because of the prevention benefits is likely to be cost-effective [8]. In addition, there is strengthening empirical evidence that primary prevention interventions such as opioid substitution treatment (OST) and needle and syringe programmes (NSP) can reduce HIV and HCV [9][10][11][12]. However, theoretical model projections suggest that substantial reductions in HCV transmission among PWID will require both traditional harm reduction/primary prevention and HCV treatment scale-up [13,14]. The ease of administration of these new DAA therapies means that they could be delivered by non-specialists in the community and within drug treatment services, leading to the recommendation that HCV treatment, drug treatment and prevention services should be integrated, which may have advantages and disadvantages in the way that drug treatment services are delivered [15].International clinical guidelines recommend that people at risk of transmitting HCV are treated for HCV [16][17][18]. The World Health Organization Global Health Sector Strategy (GHSS) on Viral Hepatitis has set a challenging goal of eliminating viral hepatitis as a major public health threat by 2030, reducing new chronic infections by 90% and mortality by 65%. In most countries these targets can be achieved only through scaling-up both OST, NSP and HCV treatment for PWID, as highlighted in a recent paper (the first in our series) on HCV in Greece [19]. Another model study in our series shows that managing HCV in prisons can make a substantial contribution to reducing transmission in the community [20]. Several countries, such as Australia, France, Georgia and Portugal, have already announced and started national HCV elimination campaigns, increasing the number of HCV treatments available and removing any restrictions on access [21,22]. There are great o...

Cost‐effectiveness of scaling‐up HCV prevention and treatment in the United States for people who inject drugs

“…Despite the high incidence of HCV in PWID and professional society guidelines and recommendations advocating HCV treatment for PWID [76,77] , few active PWID have received treatment for HCV [77,78] . Reaching and engaging PWID has challenges associated with the illicit nature of injecting drug use and stigma, discrimination, and mistrust of health services [78] .…”

“…Despite the high incidence of HCV in PWID and professional society guidelines and recommendations advocating HCV treatment for PWID [76,77] , few active PWID have received treatment for HCV [77,78] . Reaching and engaging PWID has challenges associated with the illicit nature of injecting drug use and stigma, discrimination, and mistrust of health services [78] . However, successful treatment outcomes have been achieved in numerous settings, with integration of HCV care in substance use treatment settings or co-locating primary health care services and behavioral health services, including MAT and SSP, likely enhancing medication adherence [79] .…”

Evaluation of a hepatitis C virus core antigen assay from venepuncture and dried blood spot collected samples: A cohort study

“…While the good performance of HCV core antigen in plasma has been demonstrated, there are many settings for which the collection or transport of plasma to a central facility is not possible. Dried blood spot (DBS) utility as an alternative sample type in HCV serology and molecular testing (NAT) has been well documented . The major advantages of finger‐stick capillary DBS testing are as follows: (a) simplified collection with no need for phlebotomy (through self‐ or assisted‐collection); (b) easy and affordable transportation of samples (no cold chain transport requirement as samples are stable at room temperature (24°C), with HCV RNA and core antigen stable for a year or more allowing shipment through the mail) and (c) multiple sample availability; as up to five spots are collected, which allows for reflex testing if confirmation is required or multi‐analyte testing.…”