Achieving the elimination of hepatitis C in people who
inject drugs will require a comprehensive health system-wide strategy that
addresses stigma, barriers to care, financing, the involvement of people who
inject drugs and devolution of treatment services to community level, according
to an expert review published this month in Liver
The expert review identified a range of actions which need
to be taken at health system level to improve access to treatment and
prevention for people who inject drugs. The actions are not just the provision
of services, but also changes in the way that services are designed and
delivered. These changes need to be promoted from the top in the health system
and form part of planning and monitoring.
The authors identified actions relating to each of the World
Health Organization’s six health system building blocks and highlighted actions
relating to communication and participation as essential to the hepatitis C
Half of all hepatitis C infections in people who inject
drugs are found in four countries: Brazil, China, the Russian Federation and
the United States.
Evidence from clinical trials and observational studies
shows that needle and syringe programme and opioid substitution therapy reduce
the risk of hepatitis C virus acquisition in people who inject drugs. Direct-acting antiviral
treatment is highly effective in curing hepatitis C in drug users.
However, making these interventions available, and
diagnosing drug users with hepatitis C and linking them to care require changes
in the health system to be made available at a large scale. The expert review
identified a range of actions that can be taken to improve access to treatment
and prevention services for people who inject drugs.