title: Simplification of antiviral hepatitis C virus therapy to support expanded access in resource-limited settings.
abstract: Currently, access to treatment for HCV is limited, with treatment rates lowest in the more resource-limited countries, including those countries with the highest prevalence. The use of oral DAAs has the potential to provide treatment at scale by offering opportunities to simplify drug regimens, laboratory requirements, and service delivery models. Key desirable characteristics of future HCV treatment regimens include high efficacy, tolerability, pan-genotype activity, short treatment duration, oral therapy, affordability, and availability as fixed-dose combination. Using such a regimen, HCV treatment delivery could be greatly simplified. Treatment could be initiated following confirmation of the presence of viraemia, with an initial assessment of the stage of liver disease. A combination DAA therapy that is safe and effective across genotypes could remove the need for genotyping and intermediary viral load assessments for response-guided therapy and reduce the need for adverse event monitoring. Simpler, safer, shorter therapy will also facilitate simplified service delivery, including task shifting, decentralization, and integration of treatment and care. The opportunity to scale up HCV treatment using such delivery approaches will depend on efforts needed to guarantee that the new DAAs are affordable in low-income settings. This will require the engagement of all stakeholders, ranging from the companies developing these new treatments, WHO and other international organizations, including procurement and funding mechanisms, governments and civil society.
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Treatment Action Group, New York, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Swan
authors.affiliation: Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Beyer
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Hirnschall
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Philippa
authors.initials: P
authors.lastname: Easterbrook
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland. Electronic address: Wiktors@who.int.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wiktor
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends*; D003906:Developing Countries; D005838:Genotype; D017048:Health Care Costs; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000592:standards / Q000639:trends*; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D011634:Public Health / Q000592:standards / Q000639:trends; D016896:Treatment Outcome; D014944:World Health Organization
chemical_list: D000998:Antiviral Agents
keywords: Access; Direct-acting antivirals; Scale-up; Simplification