title: Ten priorities for expanding access to HCV treatment for people who inject drugs in low- and middle-income countries.
abstract: Of the estimated 130-150 million people who are chronically infected with hepatitis C virus, around 90% reside in low- and middle-income countries. People who inject drugs are disproportionately affected by HCV, with a global estimated prevalence (based on serological reports of HCV antibodies) of 67%; world-wide over 10 million people who inject drugs are infected with HCV. Treatment for HCV has improved dramatically in recent years with the arrival of new direct acting antivirals (DAAs) and this is stimulating considerable efforts to scale up access to treatment. However, treatment coverage among the general population is less than 10% in most countries, and coverage for people who inject drugs is generally much lower. It is estimated that globally around 2 million people who inject drugs need treatment for HCV. The DAAs offer significant potential to rapidly expand access to treatment for HCV. While the ideal combination therapy remains to be established, key characteristics include high efficacy, tolerability, pan-genotypic activity, short treatment duration, oral therapy, affordability, limited drug-drug interactions, and availability as fixed-dose combinations and once daily treatments. This paper outlines 10 key priorities for improving access to HCV treatment for people who inject drugs: (1) affordable access to direct acting antivirals; (2) increased awareness and testing; (3) standardization of treatment; (4) simplification of service delivery; (5) integration of services; (6) peer support; (7) treatment within a framework of comprehensive prevention; (8) tracking progress; (9) dedicated funding; and (10) enabling policies.
authors.affiliation: Department of HIV/AIDS and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland. Electronic address: fordn@who.int.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Department of HIV/AIDS and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wiktor
authors.affiliation: Treatment Action Group, New York, USA.
authors.forename: Karyn
authors.initials: K
authors.lastname: Kaplan
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Andrieux-Meyer
authors.affiliation: Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: I-MAK, New York, USA.
authors.forename: Priti
authors.initials: P
authors.lastname: Radhakrishnan
authors.affiliation: ACCESS, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Londeix
authors.affiliation: Médecins du Monde, Paris, France.
authors.forename: Chloe
authors.initials: C
authors.lastname: Forette
authors.affiliation: Public Health Program, Open Society Foundation, New York, USA.
authors.forename: Azzi
authors.initials: A
authors.lastname: Momenghalibaf
authors.affiliation: Department of HIV/AIDS and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Annette
authors.initials: A
authors.lastname: Verster
authors.affiliation: Treatment Action Group, New York, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Swan
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D003906:Developing Countries / Q000706:statistics & numerical data*; D006291:Health Policy; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000534:rehabilitation
chemical_list: D000998:Antiviral Agents
keywords: Direct acting antivirals; Hepatitis C virus; People who inject drugs; Treatment