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Major gaps in harm reduction and treatment provision for people who inject drugs jeopardise the achievement of global targets for hepatitis C elimination by 2030, a review of hepatitis C treatment and care has found.
The review is published by the hepCoalition’s mapCrowd platform, which is intended to gather the most up-to-date global data on hepatitis C by crowd-sourcing through local experts and advocates.
The new report, Access to hepatitis C treatment and care among people who inject drugs: failing people most disproportionately affected, combines crowd-sourced data with data collected by the World Health Organization and Harm Reduction International’s State of Global Harm Reduction report, and finds:
- Globally, the hepatitis C virus (HCV) antibody prevalence among people who inject drugs is estimated to be 52.3%.
- Out of the estimated 15.6 million people (3.2 million are women) who inject drugs globally, 6.1 million of them are chronically infected with HCV (or have a 39.2% viremic prevalence).
- One in three HCV deaths are attributable to injecting drug use.
- Nearly a quarter of the world’s new HCV infections occur among people who inject drugs.
- Four countries (Brazil, China, Russia, and the United States) have the most people with recent injecting drug use who are living with HCV. Together these countries make over half (51%) of all people with recent injecting drug use living with HCV worldwide.
However, the survey found numerous gaps in global programming and services for people who inject drugs, calling into question the possibility of achieving targets for elimination of hepatitis C by 2030. These included:
- Widespread lack of needle and syringe programming and opioid substitution treatment, both proven to reduce the risk of hepatitis C transmission.
- Lack of attention to people who inject drugs in national viral hepatitis elimination plans and lack of involvement of key populations including people who inject drugs.
- Treatment guidelines still require abstinence from active drug use to obtain hepatitis C treatment despite evidence from clinical trials of high cure rates in active drug users.
- Hepatitis C treatment out of reach of drug users due to lack of health insurance and high out-of-pocket costs of treatment.
- Poor treatment uptake among people who inject drugs due to criminalisation of drug use, stigmatisation and lack of testing and treatment in prisons.
The report makes a series of recommendations for advocacy including:
- Reliable access to pangenotypic treatment and introduction of generic versions of direct-acting antivirals to simplify treatment and reduce costs.
- Allow non-specialists to prescribe direct-acting antivirals.
- Train health professionals in harm reduction and community-friendly healthcare approaches that destigmatise drug use and sex work.
- Expand needle and syringe programmes and increase coverage (number of needles and syringes distributed to drug users).
- Decentralise and simplify diagnostics for hepatitis C.
- Train, remunerate and integrate peer workers into the hepatitis C care cascade.
- Involve people who inject drugs in national elimination planning.
- Reform drug policy to decriminalise drug use.
- Involve Ministries of Justice in hepatitis elimination planning.
- Obtain political and funding commitments from Ministries of Health and Justice to achieve elimination in drug users.
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