Cure and Control: What Will It Take to Eliminate HCV?

Abstract

In May 2016, the World Health Organization adopted the first global hepatitis strategy, setting the ambitious goal of “elimination of viral hepatitis as a public health threat” by 2030. HCV-specific targets included a 65% reduction in HCV-related mortality and an 80% reduction in HCV incidence. Globally, an estimated 71 million people were living with chronic HCV infection in 2015. Approximately two million new HCV infections occur annually, with injecting drug use and unsafe health-care practices (including unsterile health-care injection), the predominant modes of HCV transmission. The development and availability of highly effective direct-acting antiviral agents (DAAs) have revolutionised HCV management and provide the therapeutic tools required to strive for elimination. For HCV treatment as prevention to have greatest impact, HCV testing and treatment coverage must be high, with new diagnoses linked expediently to care and treatment. In 2015, of the 71 million people living with HCV infection, only 20% (14 million) were diagnosed, and of those diagnosed, 13% (1.1 million in 2015, 1.76 million in 2016) had initiated DAA treatment. This chapter outlines the United Nations and World Health Organization elimination targets; defines the epidemiological concepts of control, elimination and eradication; and discusses the important lessons learnt from control and elimination efforts in other infectious diseases epidemics. The biological and technical feasibility of HCV control and elimination is discussed, followed by related financial, political and social considerations. Examples of national HCV strategies are presented, highlighting the facilitators and barriers to successful implementation of HCV elimination strategies. Control and elimination of HCV infection will require an enormous public health, political and economic commitment. The costs and risks may be high, but so too are the potential benefits.