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EASL: Governments ‘turned their backs’ on HCV prevention-as-treatment

In a recent commentary, EASL leadership focused on “micro-elimination” techniques in the fight against hepatitis C virus, explaining that while treatment of HCV with direct-acting antiviral agents is central to the elimination campaign, their high cost confirms the importance of prevention and education about transmission.

“Many governments have turned their backs on [elimination through treatment] as a goal, reserving DAA treatment only for the sickest,” Jeffrey V. Lazarus, MD, from the Centre for Health and Infectious Disease Research at Rigshospitalet, University of Copenhagen, and colleagues wrote. “The most pragmatic approach would be to break down national elimination goals into smaller goals for individual population segments, for which treatment and prevention interventions can be delivered more quickly and efficiently using targeted methods.”

Prevention, they wrote, “makes good sense from a public health perspective, but it also allays concerns that governments and other funders might be drawn into an endless cycle of paying for the retreatment of people who have been cured before.”

While many countries have already begun to focus elimination strategies toward patients with advanced liver disease, pursuing micro-elimination means targeting subpopulations such as patients coinfected with HIV, men who have sex with men, prisoners, patients with hemophilia and people who inject drugs as well as specific geographical locations.

“The greatest obstacles to HCV control are the challenging social realities of those most affected by the disease,” the authors wrote. “The complex nature of their situations makes them almost impossible to reach with a one-size-fits-all approach.”

According to Lazarus and colleagues, defining these subpopulations will also make it possible to adapt case findings, treatment settings and surveillance techniques to specific needs, as some of these subpopulations are outside standard access-to-care surveillance methods.

“The entire hepatitis elimination effort, micro- or otherwise, depends on improving the availability of reliable data to describe the epidemiology of HCV in a country,” the authors concluded. “The strategic implementation of micro-elimination campaigns, the public tracking of their progress and the sharing of lessons learned from these efforts can generate the momentum needed for the entire world to achieve the WHO hepatitis C elimination targets by 2030.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.