Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

Abstract

Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7. 5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.

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

“…Despite epidemiological estimates relating to hepatitis C prevalence and burden of disease within PWID, there are still gaps in research and monitoring data. Addressing evidence gaps and improving methods for data collection is a priority for meeting global hepatitis C elimination goals …”

“…There are many barriers to enhancing hepatitis C prevention, diagnosis, linkage to care and treatment to achieve the WHO targets among PWID. Challenges include 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 …”

“…Challenges include 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. 4,9 However, recent advances in the simplification of hepatitis C testing, diagnosis and treatment present an opportunity to enhance hepatitis C care among PWID. On 5 September 2017, prior to the 6 th International Symposium on Hepatitis in Substance Users (INHSU 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.…”

A latent class approach to identify multi‐risk profiles associated with phylogenetic clustering of recent hepatitis C virus infection in Australia and New Zealand from 2004 to 2015

“…While variations exist in the incidence and prevalence of HCV infection among HIV‐positive GBM across geographical regions, transmission of HCV has been sustained among this population in recent years . Ongoing and overlapping transmission of HCV among these groups highlights the need for further investigation of factors that influence transmission of this virus . While it is hypothesized that treatment as prevention strategies using direct‐acting antiviral (DAA) therapies may contribute to HCV elimination , more detailed characterization of the transmission of HCV is needed to guide the implementation of these strategies .…”

Barriers to effective management of hepatitis C virus in people who inject drugs: Evidence from outpatient clinics

“…Although access to care is guaranteed to all persons with HCV, the proportion of HCV patients receiving DAA therapy in Italy remains low. The lack of HCV treatment among PWIDs in high-income countries is due to several factors [21][22][23][24][25][26][27][28][29][30][31]. Some barriers to care persist even after the advent of DAAs [32,33].…”