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Nobody Left Behind

The importance of integrating people who inject drugs into HCV treatment programs. Arguments from a public health and human rights perspective.

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The World Health Organization (WHO) has called the hepatitis C virus (HCV) a “viral time bomb”. At the 2010 World Health Assembly, it recognized the viral hepatitis epidemic as “a global public health problem”, calling for comprehensive programs that “enhance access to affordable treatment in developing countries”.

In addition, it adopted a new resolution on viral hepatitis at the 2014 World Health Assembly, noting for the first time that, “hepatitis C virus, disproportionally impacts people who inject drugs” and urging member states to “implement comprehensive hepatitis prevention, diagnosis and treatment programs for people who inject drugs, including the nine core interventions”.

The vast majority of people with chronic HCV infection live in low- and middle-income countries, where access to HCV treatment remains, in general, very limited. While access to HCV treatment is likely to improve over the next few years, if current trends continue, people who inject drugs (PWID) will continue to be more or less systematically excluded from treatment programs.

This document develops core arguments for why it is relevant, feasible, and indeed crucial to include people who inject drugs in national treatment guidelines and programs for chronic HCV infection – from both public health and human rights perspectives.

Table of contents

  • The HCV epidemic
    • Documenting treatment needs among people who inject drugs in Tbilisi, Georgia
  • Access to prevention and treatment is a human right!
    • Prices of HCV treatment are exorbitant
    • Harm reduction and treatment services are scarce
    • The need for non-criminalizing drug policies
  • Treating people who inject drugs is safe, and it works!
    • Effectiveness of HCV treatment among people who inject drugs
    • Treatment adherence, discontinuation, and side effects
    • Reinfection
    • Treatment: entry point to harm reduction programs
  • Treating people who inject drugs prevents further infections!
    • Treatment as prevention

"Repressive drug policies is the major structural driver of HCV and HIV transmission."