title: The promise of treatment as prevention for hepatitis C: Meeting the needs of people who inject drugs?
abstract: Treatment as prevention (TasP) is a concept common to the HIV sector. In this commentary we draw on the literature addressing HIV and HCV TasP, alongside qualitative HCV research, to critically appraise the promise of TasP for HCV and assess the needs of PWID in the future of HCV care. With the advent of highly effective direct-acting antiviral HCV treatments, TasP is now under consideration for HCV. A growing body of literature documents numerous social structural barriers to HCV treatment access and uptake for PWID, among whom HCV is highly prevalent. Yet these barriers - and suggestions for surmounting them - are rarely included in emergent literature on HCV TasP. Although HCV TasP has important advocacy potential for increasing treatment access among PWID, critical reflection on its implications are warranted. We outline potential limitations of TasP for HCV and the conditions under which it might be optimised. We argue that HCV treatment as a prevention strategy can only be realisable in a context of enhanced harm reduction access, meaningful community engagement, and enabling environment interventions informed by the needs and perspectives of PWID.
authors.affiliation: London School of Hygiene and Tropical Medicine, United Kingdom. Electronic address: magdalena.harris@lshtm.ac.uk.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Harris
authors.affiliation: International Network of People Who Use Drugs.
authors.forename: Eliot
authors.initials: E
authors.lastname: Albers
authors.affiliation: Treatment Action Group, United States.
authors.forename: Tracy
authors.initials: T
authors.lastname: Swan
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission; D040261:Harm Reduction; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D020380:Needs Assessment; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D000998:Antiviral Agents
keywords: Community engagement; Enabling environments; Harm reduction; Hepatitis C; PWID; Treatment as prevention