With the remarkable advances in therapy for hepatitis C virus (HCV) infection, almost all infected individuals can now be cured with short-course, well-tolerated therapy. The success of current treatment has raised the prospect that perhaps this chronic infection could actually be eliminated as a public health threat on a global scale. With this in mind, the World Health Organization (WHO) set out ambitious elimination goals, aiming to reduce new HCV infections by 90% and HCV-related mortality by 65% by the year 2030. As countries strive to meet these targets, it has become abundantly clear that elimination will take a lot more than effective medications. Although some challenges are common to all environments, the local epidemiology and health care system must be considered when developing HCV control strategies. Major improvements in the left side of the continuum of care including improved diagnostics, active case-finding and novel models of care will be required to allow the therapeutic advances to deliver a public health benefit. In addition, major innovations in prevention strategies will be required, which differ significantly across regions. In middle and high-income countries, harm reduction strategies to reduce drug-use-related transmission will be critical whereas in many low and some middle-income countries, needle safety will be paramount. Challenges and successes at every step in the continuum will be discussed with a focus on countries that are on target to meet the WHO elimination goals, particularly those that have used HCV as a tool to strengthen their health sector infrastructure. Remaining research challenges will also be highlighted, particularly the need for a protective vaccine if HCV is truly to be not just regionally eliminated, but actually globally eradicated.
CROI Conference
