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 (PWID) and people in prisons (PIP).
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. The needs of people in prisons are overlooked in two-thirds of national plans, WHO found.
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 treatment 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 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.
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.
By Keith Alcorn
Access WHO policy brief “Access to hepatitis C testing and treatment for PWID and people in prisons – a global perspective” at http://www.who.int/hepatitis/publications/idu-prison-access-hepatitis-c/en/.