What is the Best Strategy to Eradicate HCV?

This may be one of the biggest questions on the minds of public health policy officials, researchers, scientists and civil society advocates who work in HCV and related fields.

I have attended several meetings, conferences and even a summit where it was the main theme. There are many approaches from around the globe, and they are all similar in tone and focus, with eradication of the virus being the goal.

The promise that we can be rid of a life threatening virus like HCV has profound implications for the individual, the one who is fortunate enough to receive a cure or eradication of the hepatitis c virus (HCV).

For me the best strategy is to assure that as many individuals as possible can be cured, and I know what it is like to live with and to be free of hepatitis c.

As I have mentioned many times in the past, there is much more than treatment involved for some populations, and these need to be addressed as part of any effective strategy.

As new treatments have shown that HCV is curable we are seeing attention like never before to move forward with strategies to end HCV. Vaccines are still not here, and they will most certainly make a significant difference in preventing new infections, when they are available and used globally. As we know from past experience, even with vaccines we will still see infections unless there is a global commitment by all countries and persons, and what about the unsafe medical practices that cause most HCV infections outside of the developed world.

World eradication is a massive task. The work on a country-by-country basis is less daunting perhaps but still is a big job ahead for most of the world unless there is a safe vaccine that is affordable and accessible.

Should we seek eradication as a goal? I think we should, but have questions about how best we should approach it.

If treatment as prevention is a model for slowing the spread of HCV in the drug use population, we are faced with challenges that relate to issues such as cost, as we do in the overall population affected, but not limited to just treatment costs. In these populations there is a need for greatly enhanced services that may include housing and a number of things that are not necessary with those persons who are able to treat with little monitoring or services. Harm reduction is key in the most at risk group, and unless this is embraced by the policymakers we will not slow the rate of new infections. I have heard recently a few advocates speak of “Prevention as Prevention” and it is important in the PWID community. What this is saying to me is that harm reduction may well be the key approach, perhaps together with “Treatment as Prevention” as an effective approach in addressing the People Who inject Drugs population. This does not address all people living with or at risk of HCV from a global perspective, but does speak to a segment of the HCV community that is traditionally more difficult to reach.

The cost of treatment drugs is making it harder for countries that are not well resourced, and some that are perceived as higher income developed nations like the US, Canada and Europe are scrambling to wrestle with costs. Unfortunately it is often used as a reason not to treat more people. The price/cost vs. the value of curing people and preventing further illness is an argument that continues when we look at the cost of not treating people over time. Considering all of these complex issues to tackle, and some people seeking out alternative sources for generic or counterfeit drugs, it is my hope that we can resolve the issue of cost and adopt the best models for programming soon.

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