Abstract Body

Major recent advances in hepatitis C virus (HCV) therapeutic development, with highly curative well tolerated all oral regimens now available have raised the prospect that treatment could provide considerable prevention impact. Mathematical modelling has demonstrated that rapid scale-up of interferon-free direct acting antiviral (DAA) therapy among people who inject drugs (PWID) to levels of 4-8% treated per annum would lead to near elimination of HCV within 20 in settings with a chronic HCV prevalence of 25-50%.
Concerted efforts in several areas are required to enhance the feasibility of HCV treatment as prevention. HCV therapeutic regimens with pangenotypic activity, single daily dosing and short duration (4-6 weeks) would be optimum. HCV screening rates need to be increased, particularly among PWID and HIV-infected men who have sex with men (MSM). HCV treatment infrastructure needs to be broadened to provide access through community-based clinics, drug and alcohol services, harm reduction facilities, and prisons. Community engagement including peer-based worker involvement in HCV screening, disease assessment and treatment delivery programs needs to be developed. Finally, drug price reform and public health advocacy will be instrumental to enable levels of HCV treatment coverage among marginalised populations that would provide major prevention impacts.
Two major Australian HCV treatment as prevention initiatives will be described. The SToP-C project is evaluating HCV treatment as prevention in the prison system in New South Wales. A surveillance phase will monitor HCV incidence in four prisons (two maximum security, two medium security), followed by rapid scale-up of interferon-free DAA therapy with ongoing monitoring of HCV transmission. The CEASE project is evaluating HCV treatment as prevention within the HIV-infected population, predominantly MSM. Components include characterisation of the HIV/HCV population through an observational database (CEASE-d), surveillance for newly acquired HCV and modelling (CEASE-m), education of HIV prescribers in HCV management (CEASE-e) and scale-up of HCV treatment (CEASE-t).