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Forging a Path to HCV Elimination: Simpler Tests and Affordable Generics

Report of the World Community Advisory Board on HCV Generics and Diagnostics, 18-20 July 2017, Bangkok, Thailand

In July 2017, 37 treatment activists from 17 countries—including 14 low- and middle-income countries (LMICs)—met with representatives from three generics and three diagnostics companies. This Hepatitis C World Community Advisory Board meeting was an opportunity for activists to present demands and obtain strategic information from companies on critical access issues in LMICs relating to pricing policies, registration, and procurement.

The report summarizes developments in the hepatitis C virus (HCV) landscape and highlights the significant barriers—such as financing, awareness, complicated and unaffordable diagnostics, centralized service delivery, and stigma—that obstruct the sustainable scaling up of prevention, testing, and treatment services. The report also notes the key takeaways from the Community Advisory Board’s exchanges with the companies.

In the meetings with generic companies, the CAB discussed treatment access barriers and expressed our demands. The meetings with diagnostics companies revealed—in addition to the importance of price-related barriers for serology and viremia testing— the need to develop advocacy tools and trainings on HCV diagnostics. In discussions on access to both diagnostics and medicines, there were several common themes. It was noted that distributor markups and customs fees are creating additional price barriers that further strain limited budgets. Reinforcing dynamics—the need for scaled up diagnostics to drive treatment volumes and treatment regimens that can treat all sub-types of HCV—were also emphasized.

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Community Advisory Boards have long played an important role in the push to expand access to medicines and in the formulation of demands for improved responses to public health challenges. HCV Community Advisory Boards have borrowed from the precedent established by HIV activists. One key example was the 2004 HIV World Community Advisory Board formed by the International Treatment Preparedness Coalition, which was comprised of people living with HIV/AIDS and fellow comrades. CAB meetings at national, regional, and global levels have played a critical role in the exchange of information and the formulation of specific treatment access demands aimed at originator (patent holding) drug companies, scientists, and government representatives.

In this tradition, the HCV World CAB is underpinned by human rights principles. Beyond the right to health and its subsequent implications for universal access to medicines, the emphasis on human rights seeks to highlight that universal rights apply equally to key populations, many of whom suffer from active discrimination and are denied equitable access to services. CABs recognize that the most-affected communities—in particular people who inject or use drugs—play an essential role in the advocacy required to improve policies at the national and international levels. Since 2014, there have now been three different iterations of the HCV World CAB to provide space for activists in low- and middle-income countries (LMICs) to discuss some of the most pressing concerns on HCV treatment access. The report summarizes the discussions during the latest iteration, which is the first to directly integrate diagnostic companies into the agenda.