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Unitaid Makes US$31 Million Investment in Harm Reduction Efforts to Prevent Hepatitis C Among People who Inject Drugs and Others at High Risk

  • Hepatitis C is a blood-borne disease that can lead to serious liver damage and cancer when left untreated
  • Recent advances have resulted in highly effective treatments that are affordable in most low- and middle-income countries where 80% of people with hepatitis C live, yet most do not have access to care
  • Marginalized groups are disproportionately affected: four in ten people who inject drugs and one in four incarcerated individuals have an active hepatitis C infection
  • Unitaid’s investment will support efforts to reach these populations by embedding hepatitis C testing and treatment services within harm reduction programs and piloting the use of two novel/underused products aimed at reducing risks associated with injecting drugs
  • Frontline AIDS, Médecins du Monde, and PATH will lead work in ten countries to assess demand and generate the evidence needed to trigger broader scale up of hepatitis C treatment and prevention through three complementary projects
  • The investment is a major boost in support for harm reduction in low- and middle-income countries, representing a 20% increase in total funding.

Melbourne, 18 April 2023In a major boost to harm reduction efforts, global health agency Unitaid today announced a US$31 million commitment to preventing hepatitis C among people who inject drugs and other at-risk populations such as people in prisons. The prevention tools and approaches will also help prevent transmission of other blood-borne diseases including HIV.

Breakthrough advances in recent years have made hepatitis C treatment highly effective and affordable in most low- and middle-income countries. However, limited awareness and insufficient access to care severely hinder efforts to eliminate the disease, particularly amongst communities where rates of transmission are the highest.

Though people who inject drugs represent just 10% of the 58 million people infected with hepatitis C worldwide, injection drug use contributes to 43% of all new infections.

Unitaid’s funding will support the integration of hepatitis C testing and treatment within harm reduction programs and trial the use of two products to prevent infection: low dead space syringes and new, long-acting formulations of buprenorphine, a medicine used in opioid agonist therapy.

Low dead space syringes have a smaller reservoir where blood can remain after use, which limits the risk of transmitting blood-borne infections when needles are shared. Slow-release formulations of buprenorphine, a medicine that reduces opioid cravings and withdrawal, could provide a valuable option for clients who face challenges with daily doses of the oral formulation, such as high out-of-pocket expenses, police harassment, or discrimination.

Apart from some limited use in Ukraine, long-acting buprenorphine is not available in any low- or middle-income country. And, though many countries have low dead space syringes, critical gaps in understanding and user preferences have severely hindered their uptake.

“Hepatitis C is becoming increasingly relegated to neglected populations that are too often overlooked by global health responses,” said Karin Timmermans, Senior Technical Manager at Unitaid, speaking at the 27th Harm Reduction International Conference in Melbourne. “Unitaid is proud to step up in support of harm reduction approaches to treat and prevent hepatitis C among people who face the greatest barriers to care.”

“We welcome Unitaid’s commitment to preventing hepatitis C through harm reduction approaches and, importantly, for centering meaningful community involvement from its inception,” said Judy Chang, Executive Director of the International Network of People who Use Drugs (INPUD). “Funding community-led research and advocacy on the best approaches to prevent and treat hepatitis C is an important step towards promoting a more equitable health landscape. We look forward to working with Unitaid and partners to ensure our voices and perspectives are heard and represented.”

80% of all those affected by hepatitis C live in low- and middle-income countries. People who face the greatest barriers to accessing healthcare are disproportionately impacted.

Both hepatitis C and harm reduction have been critically underfunded, further marginalizing already vulnerable populations. Unitaid’s investment represents a 20% increase in funding in support of harm reduction in low- and middle-income countries.

“By prioritizing harm reduction, we can ensure that people at greatest risk have access to the tools they need to protect themselves from hepatitis C and other blood-borne infections,” said Dr Meg Doherty, Director of Global HIV, Hepatitis, and Sexually Transmitted Infection Programs, World Health Organization. “This investment will not only benefit the communities of people who inject drugs directly targeted by the projects, but it will also contribute to broader public health. We commend Unitaid for its leadership and commitment to promoting health equity.”

Implemented through three complementary projects in a total of ten countries, Frontline AIDS, Médecins du Monde, and PATH will work to ensure people at greatest risk are aware of the need for hepatitis C testing and have quick and easy access to treatment.

The projects will also generate evidence critical to enabling the broader use of low dead space syringes and long-acting buprenorphine, including understanding user preferences, addressing high costs, increasing demand, and demonstrating effective delivery.

Both products will be piloted at sites in Egypt, India, Kyrgyzstan, Nigeria, South Africa, Tanzania, Ukraine, and Vietnam. Sites in two additional countries – Armenia and Georgia – will trial low dead space syringes. All ten countries will integrate service delivery within harm reduction programs.

This latest initiative builds on a longstanding commitment from Unitaid to address hepatitis C. Previous support has helped drive down the cost of services, simplify screening and diagnosis, demonstrate effective delivery strategies to reach at-risk populations, and increase awareness.


Revati Chawla, Frontline AIDS, says: “We have the tools to prevent new Hepatitis C infections. This new program will put communities at the forefront, building evidence of effective Hepatitis C treatments and how new technologies and community-led outreach can improve health outcomes for people who use drugs.”

Helena Ranchal, Director of International Operations, Médecins du Monde, says: “To prevent hepatitis C infections in Armenia, Georgia, and Tanzania, this new harm reduction program will be guided by Médecins du Monde and its partners’ core values: care, advocacy, and empowerment. Long-lasting changes will only be achieved if the populations concerned have the power to act on their health.”

Nikolaj Gilbert, President & CEO, PATH, says: “As we work towards achieving universal health coverage, it is essential that we prioritize equitable access to acceptable and affordable healthcare, particularly for those in marginalized communities. We are grateful to Unitaid for their leadership and for the opportunity to collaborate on this important project, leveraging our market-shaping, evidence generation, health system strengthening, and community engagement capabilities.”


About hepatitis C:

  • Hepatitis C is a blood-borne infection that causes inflammation of the liver that can lead to serious damage, cancer, and death if left untreated.
  • WHO estimates that 58 million people worldwide have an active hepatitis C infection, yet only 21% are diagnosed and only 13% receive treatment.
  • There are 1.5 million new hepatitis C infections each year.
  • Most infections occur through unsafe injection practices, unsafe health care, unscreened blood transfusions, injection drug use and sexual practices that lead to exposure to blood.
  • Direct-acting antiviral (DAA) medicines are effective in curing 95% of all hepatitis C infections, but most people affected do not have access.

About harm reduction approaches for hepatitis C:

  • Needles and syringe programs reduce the spread of hepatitis C and other blood-borne diseases by promoting the use of clean and safe equipment and raising awareness about associated risks
  • Opioid agonist therapies help control opioid withdrawal and cravings and can decrease the frequency and urgency of injection, thereby limiting the risk of disease transmission
  • Awareness of hepatitis C, its routes of transmission, and easy access to testing and treatment through community-level harm reduction programs is critical to reach people with treatment and prevent onward transmission.

About low dead space syringes (LDSS):

  • LDSS are syringes with a much smaller reservoir in the tip where blood can remain after injection, thus greatly reducing the risk of blood-borne disease transmission when needles are shared.
  • Evidence on their effectiveness, particularly in LMICs is limited, but research in high-income countries suggests LDSS could reduce the risk of hepatitis C infection by 76% compared to syringes with detachable needles.

About long-acting buprenorphine (LAB)

  • LAB is a relatively new slow-release formulation of an existing opioid agonist therapy that provides longer-term support through a subdermal injection, compared to daily oral doses
  • Currently only in use in one LMIC (Ukraine), the product may provide a valuable alternative treatment that could overcome challenges clients face with daily visits to distribution sites, stigma, and fear of criminalization

About Unitaid

Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, cervical cancer, and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.


Source: Unitaid