Harm reduction: Unitaid invests $31 million to fight hepatitis C

• Hepatitis C is an infectious disease in which the virus is transmitted through the blood and can lead to serious liver damage, including cancer, if left untreated.
• Recent advances have made it possible to develop highly effective and affordable treatments in most low- and middle-income countries, where 80% of people with hepatitis C live; however, the majority of these people do not have access to care.
• Marginalized groups are disproportionately affected by hepatitis C: four in ten people who inject drugs and one in four people in prison have an active infection.
• Unitaid’s investment will support efforts to help these populations by integrating hepatitis C testing and treatment services into harm reduction programs and piloting two initiatives to reduce the risks associated with injection drugs.
• Through three complementary projects, Frontline AIDS, Doctors of the World and PATH will lead work in ten countries to assess demand and generate the evidence needed to scale up hepatitis C treatment and prevention in larger scale.
• Unitaid’s investment will give a significant boost to harm reduction initiatives in low- and middle-income countries, representing a 20% increase in total funding for these initiatives.

Harm Reduction and Hepatitis C

Giving a major boost in support of harm reduction, global health agency Unitaid pledged $31 million to prevent hepatitis C among people who inject drugs and other populations at risk, such as prisoners. These prevention tools and approaches will also help prevent the contracting of other blood-borne diseases, such as HIV.

Revolutionary advances in recent years have led to the development of highly effective and affordable hepatitis C treatments in most low- and middle-income countries. However, lack of awareness and gaps in access to care are seriously hampering efforts to eradicate this disease, especially in communities where transmission rates are highest.

Although people who inject drugs represent only 10% of the 58 million people infected with the hepatitis C virus worldwide, 43% of new infections are due to injecting drug use.

Unitaid’s funding will support the integration of hepatitis C testing and treatment into harm reduction programs and will allow the testing of two products aimed at preventing infections: low dead space syringes and new formulations of long-acting buprenorphine (a drug used as part of opioid agonist therapy).

In syringes with low dead space, the reservoir that can hold blood after use is smaller than in normal syringes, which limits the risk of contracting blood-borne infections in the event of needle sharing. Long-acting formulations of buprenorphine, a drug that helps reduce the effects of opioid dependence and withdrawal, may be a viable option for clients who have difficulty accessing oral formulations of this product on a daily basis, due to high non-refundable fees, harassment by law enforcement or acts of discrimination.

Except for limited use in Ukraine, long-acting buprenorphine is not available in any low- or middle-income country. And, although many countries have low dead space syringes, significant gaps in understanding and user preferences have severely impeded their adoption.

“Hepatitis C is increasingly being relegated to neglected populations who too often are not sufficiently targeted by global health interventions, ” said Karin Timmermans, Technical Officer at Unitaid, during the 27th International Risk Prevention Conference, Melbourne. “Unitaid is very proud to be able to act in favor of harm reduction approaches in the context of the treatment and prevention of hepatitis C among those whose access to care is most hindered.”

“We welcome Unitaid’s commitment to hepatitis C prevention through risk prevention approaches and, in particular, the importance the organization has placed on meaningful community engagement since its inception” said Judy Chang, Executive Director of the International Network of People who Use Drugs (INPUD). “Funding community-led research and advocacy around the best approaches to hepatitis C prevention and treatment is a major step forward in promoting a more equitable health environment. We look forward to working with Unitaid and other partners to ensure our voices are heard and taken into account.”

Of all people with hepatitis C, 80% live in low- and middle-income countries. People who have the most difficulty accessing healthcare are disproportionately affected by this disease.

Hepatitis C control and harm reduction efforts have so far been significantly underfunded, further marginalizing already vulnerable populations. The investment made by Unitaid represents a 20% increase in funding for risk reduction in low- and middle-income countries.

“By prioritizing risk reduction, we can ensure those most at risk can access the tools they need to protect themselves against hepatitis C and other blood-borne infections” said Dr Meg Doherty, Director of the Department of HIV, Hepatitis, Sexually Transmitted Infections (STIs) at the World Health Organization (WHO). “This investment will benefit not only the communities of people who inject drugs directly targeted by the various projects, but also public health in general. We would like to commend Unitaid for its leadership and commitment to health equity.”

Through three complementary projects in a total of ten countries, Frontline AIDS, Doctors of the World and PATH will work to ensure that those most at risk are made aware of the need for hepatitis C screening and receive quick and easy access to treatments.

These projects will also generate critical evidence to expand the use of reduced dead space syringes and long-acting buprenorphine, including gaining an understanding of user preferences, reducing costs, increase demand and ensure efficient distribution.

These two products will be tested in different facilities in South Africa, Egypt, India, Kyrgyzstan, Nigeria, Tanzania, Ukraine and Viet Nam. Reduced dead space syringes will be introduced on a trial basis in target facilities in two additional countries (Armenia and Georgia). The ten countries involved will integrate the provision of certain services into their harm reduction programmes.

This new initiative builds on a long-standing commitment by Unitaid to the fight against hepatitis C. The organisation’s previous projects have helped to lower the costs of services, simplify screening and diagnosis , demonstrated the effectiveness of strategies targeting at-risk populations and improving awareness.

Doctors of the World is implementing this project in collaboration with INPUD (International Network of People who Use Drugs) , the Burnet Institute and the University of Bristol.

Photographs 

© Olivier Papegnies