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 bloodborne 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”.

HIV has demonstrated that effective treatment, while essential, will not conquer an epidemic without a robust community response, resource mobilization and political will. As with HIV, therapeutic advances have created an opportunity to halt and reverse the HCV epidemic. HCV treatment has been transformed by direct-acting antivirals (DAAs), highly effective and tolerable oral drugs that cure more than 95% of people in eight to 12 weeks. 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.

In addition to mortality and incidence reduction targets, the GHHS includes service delivery targets so that countries can monitor their progress and maximize their investment in individual and public health by deploying prevention and treatment – both of which will be required to achieve the WHO 2030 elimination targets. Ongoing access to HCV prevention is essential to HCV elimination since people become susceptible to HCV re-infection after they have been cured. Despite this, less than 1% of all people who inject drugs live in countries where high coverage of evidence-based harm reduction interventions and programmes are available, and access to them is endangered by funding cuts, Global Fund transition plans and other donor withdrawal.