Only twelve countries, including Australia and excluding the USA, are on track to achieving elimination by 2030. In order to achieve this the world will need to treat 10 million HCV positive people per year. In the “warehouse” year in 2017, 1.5 million were treated.
Cost has been one of the major barriers to achieving the goal. Some countries, like Australia, successfully negotiated an acceptable/ affordable price but importantly also committed to providing unrestricted initial and ongoing access to treatment. Other countries have imposed restrictions which reflect prejudices about such things as drug and alcohol use rather than being evidence-based, as it has been proven that all candidates do well with treatment regardless of social factors or disease stage. In addition, early treatment of active injecting drug users who are a source of ongoing disease transmission is essential. Margaret gave a fervent “call to arms” to delegates to lobby their governments to embark on aggressive price negotiations with pharmaceutical companies to attain affordable treatments for all, and also to change medication licensing arrangements which currently restrict treatment access. She challenged clinicians to be “disruptive” and to write prescriptions and provide information about importation of inexpensive generic medications. Governments should be persuaded by modeling that demonstrates that the initial costs of elimination of HCV, which may seem high in the initial phases, in fact disappear by 2030 and are offset along the way and subsequently by indirect cost savings.
Other strategies that were suggested to achieve the elimination goal include:
- High quality harm reduction programs, such as needle exchange and opioid substitution
- Increased testing and diagnosis
- Repeat testing and treatment for re-infection in high risk groups
- Better rapid tests
- More accessible treatment services extending treatment away from hospital clinics to primary care, mobile vans, nurse and pharmacy- based sites
- The development of a vaccine
Author bio: Dr Jane Hunt is a GP working in high case-load HIV practice at Holdsworth House Medical Practice (HHMP) in Darlinghurst N.S.W.
