This is an historic moment for hepatitis C treatment. With the advent of direct-acting antivirals (DAAs), we can now massively reduce the harm from an infectious disease that affects millions of people and causes hundreds of thousands of unnecessary deaths every year. Interferon-free DAA regimes are short, highly tolerable, and simple to deliver, with cure rates of >90%. One year ago, the first World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis1 was approved with the ambitious goal of hepatitis C elimination as a public health threat by achieving a 90% reduction in new infections and a 65% reduction in deaths from the hepatitis C virus (HCV) by 2030.
The use of unsterile drug-injecting equipment is a primary contributor to the HCV epidemic in Europe. Over 90% of new infections are among people who inject drugs (PWID).2 Other populations at high risk for HCV include migrants from high prevalence countries/regions, prisoners, people who are homeless, sex workers, people living with HIV, and men who have sex with men.
Major European and international agencies such as the WHO, United Nations Office on Drugs and Crime (UNODC), Joint United Nations Programme on HIV/AIDS (UNAIDS), European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), and European Centre for Disease Prevention and Control (ECDC) consider viral hepatitis, especially among PWID, to be a serious public health problem. However, at present, policies responding to HCV are inconsistent, or non-existent across Europe. The broad range of issues pertaining to HCV have not been exhaustively included in European and/or national policies or comprehensively dealt with among designated stakeholders.
HCV prevention, screening, early diagnosis, and treatment among PWID have been proven to be both effective and cost-effective.3 Research exploring the values and preferences of PWID with regard to HCV treatment has found that concerns exist about side effects, limited HCV knowledge, rationed treatment expectations, experiences of treatment refusal due to drug use, stigma and discrimination within healthcare settings, and difficulties associated with hospital systems pose significant hurdles for HCV treatment access and uptake.4
Consequently, hepatitis C elimination will require an enormous scale-up in testing and treatment along with comprehensive harm reduction services, including in prisons. The other essential requirement for achieving the elimination of hepatitis C is a sustained collaborative effort to combat the stigma, discrimination, and criminalisation5 faced by PWID and other priority communities, such as migrants and men who have sex with men. Again, community and civil society actors hold a vital key to succeeding in this effort.
On 18th–19th of April, just before the International Liver CongressTM (ILC) organised by the European Association of the Study of the Liver (EASL) in Amsterdam, Netherlands, a Community Summit on hepatitis C came together with an urgent call to policy makers, healthcare providers, health insurance providers, and the pharmaceutical industry to work in collaboration with the affected communities and their organisation, as well as low-threshold services, to achieve the scale-up. Communities and community representatives must participate in formulating and implementing hepatitis C prevention, testing, and affordable treatment strategies because these stakeholders have unique knowledge about what will be accessible, acceptable, and effective. Without their close ongoing involvement, the effort to eliminate hepatitis C is likely to fail.
In a ‘Civil Society Declaration on the Importance of Civil Society Involvement’, it is stated:
“Together, we can improve access to care for marginalized populations and hold governments accountable to their commitment to the Global Health Sector Strategy on Viral Hepatitis.”
The declaration is signed by numerous European networks and organisations and is accessible at www.hepatitiscommunitysummit.eu.