2018 IAS Brief Document Ending an Epidemic – Prioritizing People Who Inject Drugs in HCV elimination Efforts.

Fuelled by political will, resources for cost-effective, evidence-based prevention programmes and revolutionary advances in hepatitis C virus (HCV) treatment, momentum is building towards halting a deadly global epidemic. Worldwide, an estimated 71 million people are living with hepatitis C, a blood- borne virus that infects liver cells. Without treatment, HCV can progress to liver cirrhosis, liver failure and liver cancer. In 2015 alone, 400,000 people died from these complications globally.

Nearly a quarter of the world’s new HCV infections occur among people who inject drugs (PWID): lack of access to sterile needles, syringes and other injection equipment renders them highly vulnerable to HCV. Legal and structural barriers also greatly increase HCV risk among PWID. Worldwide, more than 50% of the 15.6 million PWID are HCV antibody positive. Without urgent, strategic and measurable action that includes PWID, HCV will continue to inflict a staggering, and increasing, burden of preventable illness and death among families, communities and countries. The World Health Organization (WHO) has described it as a “viral time bomb”.

Just five years ago, the standard of care was interferon based treatment, which had suboptimal effectiveness, debilitating side-effects, and was unsuitable for scale up in resource-limited settings. DAAs have made HCV elimination a tangible goal – and the world has signed on to do so. At the World Health Assembly in May 2016, 184 Member States adopted the WHO Global Health Sector Strategy (GHHS) on viral hepatitis.

Countries can also deploy HCV treatment as prevention (TasP). The success of TasP among PWID relies on the extent of treatment coverage. Low-level coverage will not reduce prevalence enough to prevent many new infections/ re-infections. Higher treatment coverage could dramatically reduce HCV prevalence and, thereby, the incidence of new infections and re-infections.

Investment in HCV and population impact can be maximized by countries through combining treatment and prevention interventions (to prevent infection and re-infection). TasP is more effective with high-coverage NSP and OST than by itself, and combination prevention strategies are likely needed in most settings, particularly in areas with high HCV burden among PWID.

The obstacles that limit access to DAAs differ across low-, middle- and high-income settings – except for the arbitrary legal, structural and treatment barriers facing PWID, which exist in all countries. These must be addressed to achieve elimination goals.

High prices are often used as a justification for withholding treatment from PWID, but in countries where they are available, prices for generic DAAs are dropping – and they could be profitably mass produced for less than US$50 per treatment course. Research on, and implementation of simple and affordable rapid tests and one-step diagnostics, including core antigen testing and finger-stick testing for viral load, could facilitate diagnostic scale up

As with HIV, political will and an enabling environment are needed to stop HCV. Unless harsh drug policies change and unless national plans are funded and implemented, many countries will not be able to achieve the 2030 elimination targets, even with access to affordable generic DAAs.

Inside this brief report there are some country snapshots from India, Morocco and Thailand and detail IAS brief document on ending HCV epidemic can be access to the link below


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