Since the introduction of direct-acting antiviral therapies, which boast a 95% cure rate, the reported number of HCV cases has fallen.
The World Health Organization (WHO) set a goal in 2016 of reducing chronic hepatitis C virus (HCV) by 90% and mortality 65% by 2030. Attaining that goal, writes a team of Israeli physicians, will take cooperation, coordination, and innovation among governments and health care systems worldwide to overcome barriers to care.
“The elimination of chronic HCV is urgent and important,” the physicians posit in a June 2023 article published in the journal Virus. “To reach this goal, clever interventions by health systems to overcome barriers are needed. Resources, training, and awareness are important factors for success.”
Since the introduction of direct-acting antiviral therapies, which boast a 95% cure rate, the reported number of HCV cases has fallen. Nevertheless, there are approximately 1.5 million new HCV cases per year and as many as 58 million people infected worldwide, according to the WHO. Included in that number are 3.2 million adolescents and children. The WHO estimates that HCV claimed the lives of 290,000 people in 2019, most from complications with cirrhosis caused by the disease.
But for the WHO’s crusade to eliminate HCV to succeed, authors assert more must be done to remove access and barriers to treatment, including addressing costs, adding healthcare resources, increasing awareness of HCV and the treatments available, and the consequences of not being screened and treated.
“While there have been significant advances in the treatment of hepatitis C, many people still do not have access to treatment,” the physicians wrote. “Barriers exist at many levels, from the provider and patient, to the overarching system.”
The place to start, the authors believe, is with effective prevention and intervention strategies to reduce the transmission of HCV, especially among people who inject drugs (PWIDs). Intervention is needed to screen, diagnose, and treat at-risk populations.
Screening and antibody testing should be available to all, but programs should prioritize intravenous drug users, people who received blood transfusions pre-1992, pre-1992 organ transplant recipients, infants born to HCV infected mothers, hemodialysis patients, men who have sex with men, and migrants from a country with a high rate of HCV infection.
Decentralizing HCV treatment centers can help treat the homeless and hard-to-reach minorities while cutting testing red-tape can expedite services. But interventions and treatment, the doctors caution, must be “designed and carried out” by the health ministry, health organizations, and third-party organizations.
“Cultural beliefs, practices, and misconceptions about hepatitis C affect individuals’ perceptions and decisions about screening,” wrote the doctors. “Interventions are necessary at the patient level to overcome the aforementioned obstacles.”
Family physicians, often the first point of contact for an HCV patient, can play a crucial role in beginning and tracking treatment. But many family practitioners are already overbooked. The authors recommend adding more medical workers, clinics, and resources for contacting, testing, and treating patients.
The main barrier at the patient level is awareness. Increasing patient awareness about HCV testing and the long-term consequences of untreated HCV can be done through local and national public service ads that are culturally and linguistically adapted to each country and community.
“Promoting international collaboration and coordination among countries, organizations, and stakeholders to share best practices, resources, and expertise in HCV elimination efforts is pivotal,” the authors conclude. “This involves partnerships with global health organizations, governments, civil society, and other stakeholders to leverage collective efforts.”