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Commentary
Hepatitis C elimination by 2030 through treatment and prevention: think global, act in local networks
  1. M Hellard1,2,3,
  2. R Sacks-Davis1,4,
  3. J Doyle1,2,4
  1. 1Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
  2. 2Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
  3. 3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Professor M Hellard, Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; hellard{at}burnet.edu.au

https://doi.org/10.1136/jech-2015-205454

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    Hepatitis C virus (HCV) elimination is now an achievable goal;1–3 the WHO is likely to set ambitious but achievable 2030 elimination targets later this year.4 In high-income countries, people who inject drugs (PWID) are the group at greatest risk of HCV infection,5–7 with HCV prevalence among PWID varying from 10% to 97% in different regions of the globe.7 ,8 In low income and middle income countries, HCV transmission can be due to iatrogenic transmission (in the formal and informal health systems), injecting drug use or a combination of the two.9

    Highly effective direct-acting antiviral (DAA) treatment with improved tolerability is the cornerstone of HCV elimination. Models that combine HCV treatment as prevention and harm reduction services—including opioid substitution therapy (OST) and needle and syringe programmes (NSPs)—suggest that HCV prevalence and incidence can be significantly reduced and the proposed WHO elimination targets can be met.10 ,11 In countries with significant levels of iatrogenic transmission, health system strengthening is also required.12

    The concept of disease eradication and elimination is a daunting prospect: only one infectious disease, smallpox, has been successfully eradicated from the world.13 As well as HCV, the 2030 elimination targets include malaria, tuberculosis and HIV, all of which involve considerable challenges. In part, this is due to how they are transmitted: malaria is vector-borne, making it unlikely that the disease reservoir can be totally eliminated. Tuberculosis is airborne, making transmission difficult to control, and the treatment duration is long, making multidrug resistance possible if therapy is not taken correctly. Although HIV can be well controlled using antiretroviral therapy, it cannot be cured and there is no effective vaccine. Also, HIV prevention programmes—such as the use of condoms to stop sexual transmission—require behaviour changes to which many people are resistant14–16 …

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    Footnotes

    • Funding National Health and Medical Research Council (Early Career Fellowship, Postdoctoral Fellowship, Senior Research Fellowship).

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • ↵i Global estimates of the prevalence of hepatitis C virus in the population vary greatly. Mathers et al reported midpoint country estimates ranging from 0.02% (India and Cambodia) to 5.21% (Azerbaijan). In Western Europe (with the exception of the Netherlands, where there is very little reported injecting drug use) the prevalence ranged from 0.13% (Greece) to 0.83% (Italy). In countries like the USA, Canada, Australia and New Zealand, estimated prevalences are close to 1%.41

    • ↵ii As outlined earlier, estimated HCV prevalences in the national populations of PWID vary greatly, ranging from 10% to 97%.6 ,7