amfAR, The Foundation for AIDS Research

Treating Hepatitis C Among People Who Use Drugs

Participants during the December seminar co-hosted by TREAT Asia, OSF, and the International Network on Hepatitis in Substance Users

Data indicate that approximately 60% of the 16 million people who inject drugs (PWID) globally are infected with the hepatitis C virus (HCV), and that 75–99% of PWID who are HIV-positive are co-infected with HCV. However, PWID are much less likely to access hepatitis C treatment than other populations. In December 2014, TREAT Asia, the Open Society Foundations (OSF), and the International Network on Hepatitis in Substance Users co-hosted a seminar on treating HCV among people who use drugs. The three-day event was one of the first initiatives in the Asia-Pacific to bring leading physicians who treat HCV together with HCV treatment advocates to discuss challenges and successful methods for providing quality hepatitis C treatment to people who use drugs.

"This seminar was important because it brought together experts from different backgrounds and countries who were able to learn from each other regarding approaches that have increased access to hepatitis C care services among people who use drugs," says Dr. Nicolas Durier, TREAT Asia research director.

The 35 seminar participants came from 11 countries in Asia and Eastern Europe—the two regions with the largest numbers of PWID. Many of the physicians shared their experiences treating individuals for hepatitis C who were currently using drugs, but others stated that they had been reluctant to do so due to concerns that reduced adherence to treatment would make the chance of a cure low and of disease relapse high.

Panelists discuss treating hepatitis C among people who use drugs.

Researchers from the Kirby Institute at the University of New South Wales in Australia, a TREAT Asia partner, presented data on treatment models that increase PWID’s adherence by integrating medical care with counseling, support groups, and harm reduction activities. Many of the attendees expressed interest in collaborating to establish such models in their countries and in advocating for better government and healthcare policies regarding people who use drugs.

"During the seminar, it became clear that, while treatment access for this population is limited all over the world, the main barriers can be overcome because there is both expertise and a willingness of doctors and community advocates from many countries to work together to champion this issue," says Azzi Momenghalibaf, program officer at OSF.

The attendees also discussed the current hepatitis C treatment landscape. Due to its high cost, effective hepatitis C treatment remains largely inaccessible for all populations in resource-limited settings. Of the countries represented at the seminar, only Thailand has an established hepatitis C treatment program, although Indonesia and Vietnam recently initiated programs that are still in early phases of development. These programs include the use of the medicines pegylated interferon and ribavirin, the treatment combination most available in developing countries and supported by the World Health Organization. None of the represented countries currently pay for direct-acting antiviral (DAA) drugs, a new class of treatments that has much higher cure rates, is much easier to administer, and has far fewer side effects than the older regimen—but is prohibitively expensive.

Gilead, the maker of sofosbuvir (brand name Sovaldi), a DAA effective against the types of HCV most prevalent in the Asia-Pacific, has signed voluntary licensing agreements that will allow the sale of generic sofosbuvir in 91 developing countries. However, many of the middle-income countries in the Asia-Pacific with the highest HCV burdens are not included in the list. The participants discussed concerns that, even with these agreements, access to sofosbuvir will remain low in the region, due both to the limited number of countries included and to the "anti-diversion measures" included in the agreements that are expected to make accessing the drug more difficult for individual patients. In addition, the reduced prices may still be too high for some countries to provide the medication under their national healthcare plans.

Innovative strategies and open dialogue between countries, civil society, pharmaceutical companies, and the World Health Organization will be needed to solve the problem of how to deliver hepatitis C treatment to the people who need it most in the Asia-Pacific region and around the world.