Access to hepatitis C treatment for people who inject drugs in low and middle income settings: Evidence from 5 countries in Eastern Europe and Asia.
BACKGROUND
People who inject drugs (PWID) are disproportionately affected by the hepatitis C (HCV) epidemic. Of the estimated 16 million PWID worldwide, approximately 8 million live with chronic HCV, and around 26% and 23% of the global HCV infections among PWID occur in East/Southeast Asia and Eastern Europe respectively. Globally, few PWID have access to treatment for HCV.


METHODS
We conducted a systematic literature review and internet survey in 2014 to document the burden of disease, access to diagnosis and treatment and the existence of national policy and treatment guidelines for HCV. We included Georgia, Russia, Ukraine, Myanmar and Indonesia as countries with injection drug use epidemics.


RESULTS
HCV antibody prevalence among the general population ranged from 0.80% in Indonesia to 5% in Georgia, and among PWID from 48.1% in Myanmar to 92% in Georgia. PWID carried a significant burden of disease, ranging from 2.7% in Indonesia to 40.4% in Russia. Yearly treatment uptake was under 1% for the general population and PWID in all countries. Diagnostic tools and disease staging investigations as well as pegylated interferon/ribavirin treatment were available at a range of prices. Despite policy and treatment protocols for HCV in the majority of countries, strategies focusing on PWID were largely absent.


CONCLUSIONS
PWID are a priority group for treatment, and access to treatment should be based on sound national policy, accessible public treatment programmes and functional surveillance systems.
Médecins du Monde France, 62 rue Marcadet, 75018, Paris, France. Electronic address: niklas.luhmann@medecinsdumonde.net.
Niklas
N
Luhmann
Médecins du Monde France, 62 rue Marcadet, 75018, Paris, France.
Julie
J
Champagnat
International Treatment Preparedness Coalition in Eastern Europe and Central Asia, Dostoevskogo 38-30, St. Petersburg, Russia.
Sergey
S
Golovin
International HIV/AIDS Alliance in Ukraine, 5 Dymytrova St., Build 10A, 03680 Kyiv, Ukraine.
Ludmila
L
Maistat
Indonesian Drug User Network Persaudaraan Korban Napza (PKNI), Jalan Tebet Timur Dalam XI No. 94 Tebet, Jakarta Selatan 12820, Indonesia.
Edo
E
Agustian
Médecins du Monde Georgia, 46 Street, Gutani, Tbilisi, 0179, Georgia.
Ina
I
Inaridze
Médecins du Monde Myanmar, No (11-B) Maharmyaing Street, Sanchaung Township, Yangon, Myanmar.
Wai Moe
WM
Myint
Health Research Union, 8 Nutsubidze Str., Tbilisi 0177, Georgia.
Maia
M
Butsashvili
Médecins du Monde France, 62 rue Marcadet, 75018, Paris, France.
Julie
J
Bouscaillou
D001208:Asia; D003906:Developing Countries; D005061:Europe, Eastern; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology
Disease burden; Hepatitis C; People who inject drugs; Treatment access