Reaching people who inject drugs and people in prisons – a must for hepatitis C elimination

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Stopping the spread of infectious disease is a public health priority.

Original Source: who.int

The World Health Organization (WHO) is calling for greater commitments to scale up hepatitis C virus (HCV) testing and treatment services to people who inject drugs (PWID) and people in prisons (PIP).

Around 71 million people are infected with chronic HCV worldwide with PWID being disproportionately affected. They account for the highest proportion of new infections – 23% of the 1.75 million infections that occur every year. As for PIP, up to 1 in 4 can be HCV positive. The elimination targets set by WHO aim to diagnose 90% and treat 80% of all eligible persons by 2030.

Today at the Harm Reduction International Conference (HR19), WHO is releasing a new policy brief “Access to hepatitis C testing and treatment for PWID and people in prisons – a global perspective”. The policy brief looks at the global landscape of national hepatitis plans and country experiences, showcasing some of the gains and gaps in reaching PWID and PIP with HCV services.

New findings

The policy brief outlines the following analysis.

  • More countries have developed national hepatitis plans as at February 2019, but many of these plans overlooked the needs of PWID and PIP.
  • Of the 81 national plans and treatment guidelines reviewed by April 2019, 51 (63%) included services for PWID, and 37 (46%) did so in full alignment with the WHO “Global health sector strategy on viral hepatitis, 2016–2021”.
  • 28 (35%) plans and guidelines included services for PIP, and 23 (28%) did so in full alignment with the WHO “Global health sector strategy on viral hepatitis, 2016–2021”.
  • 11 (14%) plans and guidelines specified restrictive requirements such as drug use abstinence (commonly for a period of 6 months or longer) for PWID to be eligible for HCV testing and treatment.
  • Many national plans and guidelines also specify requirements for health insurance coverage, which presents a barrier for PWID and PIP in some countries.

Country snapshots

The policy brief also provides select country experiences:

  • Australia recently published its fifth national strategy (2018–2022) on the path to hepatitis elimination by 2030. The country used a simplified approach to service delivery, integrating hepatitis testing, treatment and harm reduction for PWID at decentralized sites, and engaging peer workers and general doctors. Concerted implementation of HCV testing and treatment in several prisons shows elimination in these settings is possible.
  • China is undertaking development of a national hepatitis plan, which references PWID as a priority population for HCV testing and treatment. The government and health insurance providers are in the process of negotiating lower prices for DAAs – the results of these negotiations will be key to the strategy’s success.
  • India launched a national action plan to combat viral hepatitis in February 2019, targeting PWID as a priority population, aiming to provide 1 000 000 DAA treatment courses annually over the next 3 years.
  • The Islamic Republic of Iran has a 3-year national hepatitis plan that proposes interventions for PWID and PIP. DAAs can be obtained for as little as US $81, but only for people with health insurance. Many PWID and PIP without insurance face a higher cost of US$ 2200.
  • Ukraine is developing a national strategy to contain tuberculosis, HIV and viral hepatitis. Generic DAAs are now available for less than US$ 100. Effective collaboration with the Ministry of Justice enabled HCV testing for 1 000 PIP living with HIV in 2018. Of these people, 50 were treated with DAAs, achieving a 98% completion rate.
  • The United States of America also has a viral hepatitis action plan and policies that target PWID and PIP. But high costs for DAAs (between US$ 15 000 and US$ 94 000) are a major implementation barrier.

Steps for HCV elimination among PWID and PIP

The WHO policy brief calls for greater political will to improve testing and treatment access for these marginalized populations. HCV treatment prices also need to drop further. Reaching PIP with public health services is feasible– and can help achieving HCV elimination within this specific population group.

Reaching PWID and PIP with HCV testing and treatment services as part of a comprehensive harm reduction approach is an essential element of hepatitis elimination efforts and embodies the principles of the Universal Health Coverage (UHC) agenda to ensure that no one is left behind.

Reflecting voices of PWID and PIP and other key and at-risk populations in shaping hepatitis elimination and UHC efforts is a critical step as well. This week, WHO is supporting the participation of 7 key population scholars in multi-stakeholder consultations, in preparation for the UN High-Level Meeting on UHC to take place in September 2019.

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