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Review
. 2019 Jan;39(1):20-30.
doi: 10.1111/liv.13949. Epub 2018 Sep 22.

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

Emma Day  1 , Margaret Hellard  2 , Carla Treloar  3 , Julie Bruneau  4 , Natasha K Martin  5 , Anne Øvrehus  6 , Olav Dalgard  7 , Andrew Lloyd  8 , John Dillon  9 , Matt Hickman  10 , Jude Byrne  11 , Alain Litwin  12 , Mojca Maticic  13   14 , Philip Bruggmann  15 , Havard Midgard  16 , Brianna Norton  12 , Stacey Trooskin  17 , Jeffrey V Lazarus  18 , Jason Grebely  8 ; International Network on Hepatitis in Substance Users (INHSU)
Affiliations
Review

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

Emma Day et al. Liver Int. 2019 Jan.

Abstract

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.

Keywords: elimination; health systems; people who inject drugs; viral hepatitis C.

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Figures

Figure 1.
Figure 1.. Estimated number of people with recent injecting drug use living with HCV viraemic infection, by country.
This figure has been reproduced with permission from.
Figure 2.
Figure 2.. Proposed modified WHO Health Systems Framework for PWID.
This figure has been modified from_ENREF_3_ENREF_3.
See this image and copyright information in PMC

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