While the development of highly curative direct-acting antiviral (DAA) therapy has transformed the treatment of hepatitis C virus (HCV) around the world, a cross-disciplinary approach to prevention and treatment, like that adopted by Australia, is required to meet the World Health Organization’s HCV elimination targets by 2030, according to an expert commentary published today in the prestigious New England Journal of Medicine (NEJM).
The commentary, written by the Kirby Institute’s Scientia Professor Gregory Dore and Dr Stacey Trooskin from Philadelphia FIGHT Community Health Centers, compares the national responses of Australia, Canada and the USA and analyses their effectiveness and progress towards HCV elimination by 2030 whilst identifying the strategies that have worked well, and where they could be enhanced.
The authors say that in order “to reduce the burden of HCV, public health and clinical responses should focus on key populations,” and go on to show that in terms of effective cross-disciplinary policy and practice that engages government, academia, clinicians and crucially, affected communities, Australia leads the pack.
The Australian Government made DAA therapy broadly available through its government-subsidised Pharmaceutical Benefits Scheme in 2016, enabling thousands of people living with HCV to receive treatment, including people who inject drugs.
Interestingly, the data shows that the uptake of DAA medication is in fact “higher among marginalized populations, including people who inject drugs, people with recent incarceration, and HIV-infected men who have sex with men, than among other people with HCV.” In particular, the high uptake of DAAs by people who inject drugs – one of the highest risk groups for HCV – has more than halved the prevalence of those with active HCV infection in Australia, from 51% in 2015 to 18% in 2019.
But it isn’t just the wide availability and uptake of treatment that has led to Australia’s impressive declines, with federal and state governments having adopted a multi-faceted suite of policy and practice strategies to bolster elimination efforts. These include a national HCV strategy framework, updated every 5 years; funding of community organisations and screening; as well as a range of harm reduction strategies such as community clinics, needle syringe programs and opioid agonist treatment.
The authors say these measures have had the benefit of reducing HCV prevalence across the board, and by developing strategies that target the group most at risk, other countries could adopt a similar rationale. From harm reduction and provision of screening and treatment services, to integrated, cross-disciplinary education and training for physicians and critically, a reduction of stigma, the authors say that those most vulnerable and at risk must not be left out, and in fact should lie at the centre of elimination efforts and decision making.
“Broad use of harm reduction has been pivotal for primary prevention and for helping connect people with screening and treatment services — and therefore for reaping the population level benefits of using HCV treatment as prevention,” they say. “It will be important to address all social and health needs of people who use drugs.”