Monitoring Hepatitis C Elimination Among People Who Inject Drugs: A Broader Approach Is Required
Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is one of the major advances in clinical medicine in recent decades and pivotal to achieving hepatitis C elimination targets by 2030. These targets have been recently revised, with a move from relative reduction to population-level mortality (less than two deaths per 100,000 per year) and incidence (less than five new infections per 100,000 per year) and inclusion of specific incidence target for people who inject drugs (less than two new infections per 100 persons years). These quantifiable measures signpost the endgame of hepatitis C elimination. But should our framework for characterizing elimination success be broader, particularly encompassing measures for drug-related harm and broader health outcomes?
The empowerment that highly curative HCV therapy provides at the individual patient and clinician levels is considerable, together with benefits such a successful therapeutic initiative creates for public health policy. The hepatitis C response can improve lives of those affected, which in many countries is predominantly people who inject drugs. A narrow focus in relation to hepatitis C elimination, on related mortality and incidence, would be a missed opportunity to advance broader health equity. The hepatitis C elimination endgame should encompass measures that address stigma and discrimination of people who inject drugs, and other aspects of equity in relation to prevention and treatment services: access to harm reduction, including for those in prison settings; flexibility and choice of drug treatment; and prevention of overdose and other drug-related harms. Furthermore, hepatitis C elimination strategies for people who inject drugs should acknowledge and address the excess mortality burden that exists, even following successful treatment.
The overall goal of hepatitis C elimination for people who inject drugs should be improved quality of life and enhanced access to high-quality, non-judgmental healthcare and prevention services, resulting in reductions in morbidity and mortality broadly.