Microelimination of hepatitis C means breaking down targets for the elimination of hepatitis C into smaller population targets. Different populations have different needs and characteristics. For example, achieving elimination of hepatitis C in people who use drugs or in people with hepatitis C and HIV co-infection will require different approaches. Whereas people who use drugs are most likely to be reached for diagnosis and treatment through drug treatment and harm reduction services, people with HIV and hepatitis C co-infection are most likely to be reached through clinical services providing HIV treatment.
In the United Kingdom, the British HIV Association (BHIVA) has set a target of eliminating hepatitis C in people with HIV and hepatitis C virus (HCV) co-infection by 2021. BHIVA says that this target is feasible because some regions of the country have already achieved very high levels of treatment and cure. However, reaching the last 20% of patients is likely to prove more challenging because these people are likely to need more support to begin treatment and because they may have complex needs including housing, addiction treatment and co-morbidities.
Public Health England estimated that approximately 3300 people with HIV were also living with hepatitis C in England at the beginning of 2016. People with co-infection form a small proportion of the entire population of people with hepatitis C in the UK but a high proportion of those becoming newly infected with HCV. The incidence of hepatitis C in HIV-positive men who have sex with men has risen over the past ten years.
BHIVA says that it wants to see every person living with HIV and hepatitis C assessed for direct-acting antiviral treatment by April 2019 and 80% cured by that point. By April 2020 BHIVA wants to see 90% of hepatitis C infections cured in people living with HIV and complete elimination the following year.
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