Study Highlights Challenges for Global HCV Control

Chronic infection by the hepatitis C virus (HCV) proved fatal for over 700,000 people worldwide in 2013, mainly as a result of liver damage. Although information on the epidemiology of transmission and infection is sparse, recent estimates put the global prevalence of HCV infection at 130-150 million people.

The World Health Organisation has initiated a strategy (2016 – 2021) to eliminate hepatitis C as a global public health threat by 2030. Specific targets will include reducing new infections each year by 70% to around 1 million and cutting the fatality rate by 60%.

A recent study explores the global challenges ahead and the interventional strategies available to meet them successfully. “One of the core elements of a global control programme against hepatitis C will be the new direct acting antiviral (DAA) drugs. These are extremely effective, with short- duration oral treatment courses achieving cure rates in excess of 90%,” explains senior author Giuseppe Ippolito (National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy).

Prevention strategies will aim at limiting infection rates in healthcare settings through increased screening of donated blood and a substantial reduction in unsafe injections. Data shows that these challenges arise mainly in countries such as Nigeria, Gabon, Egypt and India but outbreaks of hepatitis C infection in Europe due to unsafe medical practices are not unheard of. An example of iatrogenic transmission of HVC was reported as recently as 2008 in Spain.

A main challenge is to target people with the greatest need effectively. “We have effective treatments in the form of DAAs but, currently, these are neither affordable or accessible in many low and middle income countries,” cautions Ippolito. “Global pressure will be required to encourage generic competition to reduce the cost of medicines and diagnostics. This could include direct price negotiations with the pharmaceutical companies responsible for DAA manufacture, differential pricing and voluntary licences,” he adds. Other action points for consideration include increased data collection, increased access to simple, reliable drugs and expansion of public prevention awareness programmes.

Without concerted effort worldwide, the 2030 goals seem huge but successful public health programmes have already achieved similarly massive objectives – HIV being a prime example. “The global response to HCV and other infectious diseases control can learn from the innovative HIV service delivery approaches that have already been used successfully in marginalised and vulnerable populations across the world,” concludes Ippolito.

* Published in Clinical Microbiology and Infection, Lanini et al.