Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Authors: Emma Day, Margaret Hellard, Carla Treloar, Julie Bruneau, Natasha K. Martin, Anne Øvrehus, Olav Dalgard, Andrew Lloyd, John Dillon, Matt Hickman, Jude Byrne, Alain Litwin, Mojca Maticic, Philip Bruggmann, Havard Midgard, Brianna Norton, Stacey Trooskin, Jeffrey V. Lazarus, Jason Grebely

Journal: Liver International Year: 2019 Reference: 39:20-30


The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow‐up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.


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