The World Health Organization (WHO) has called for greater
commitments to scale up hepatitis C virus (HCV) testing and treatment services to
people who inject drugs and people in prisons.
In an analysis released this week to coincide with the Harm
Reduction International conference in Porto, Portugal, WHO reports that people who
inject drugs are still overlooked in more than a third of national hepatitis
plans, and the needs of people in prisons are overlooked in two-thirds of national
plans.
Furthermore, even when services are planned, they may still
impose restrictions such as abstinence from drug use to be eligible for
treatment or may require health insurance coverage to obtain treatment.
WHO says that approximately 400,000 people who inject drugs
acquire hepatitis C each year, out of an estimated global total of 1.75 million
new infections per year.
Scale-up of harm reduction services proven to reduce the risk
of acquiring hepatitis C – needle and syringe programmes and opioid
substitution therapy – must form a major part of hepatitis C prevention among
people who inject drugs, says WHO.
The WHO policy brief stresses the importance of
addressing structural barriers such as criminalisation of drug use to improve
access to treatment.
Countries should also look at how testing and treatment services
can be provided through people who inject drugs through community-based harm
reduction services such as drop-in centres, needle and syringe programmes, drug
dependence services and opioid substitution therapy sites.
Improvement of prison health services and availability of
voluntary testing and treatment for hepatitis C for all people entering prisons
are also priorities for hepatitis C elimination, as the prevalence of hepatitis
C in prisoners is much higher than in the general population. People in prison
are also at high risk of acquiring hepatitis C, through sharing of injecting
equipment and other exposures to blood.
WHO also stresses that expanding treatment coverage for people
who inject drugs and other key populations will require further reductions in
the cost of direct-acting antivirals.
WHO also highlights several examples of national plans that
have prioritised testing and treatment for people who inject drugs:
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 people who inject drugs at decentralised 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.
India launched a
national action plan to combat viral hepatitis in February 2019, targeting people who inject drugs
as a priority population, aiming to provide 1,000,000 direct-acting antiviral treatment courses
annually over the next 3 years.
The Islamic
Republic of Iran has a 3-year national
hepatitis plan that proposes interventions for people who inject drugs and people in prisons. Direct-acting antivirals can be obtained for as little as US $81, but only for people
with health insurance. Many people who inject drugs and people in prisons without insurance face a higher
cost of US$ 2200.
Ukraine is
developing a national strategy to contain tuberculosis,
HIV and viral hepatitis. Generic direct-acting antivirals are now available for less than US$ 100.
Effective collaboration with the Ministry of Justice enabled HCV testing for 1000 people in prisons living with HIV in 2018. Of these people, 50 were treated with direct-acting antivirals
achieving a 98% completion rate.