HEPATITIS C VIRUS: GONE BY 2030?

Recognizing hepatitis C virus (HCV) as a major public health threat, the World Health Organization in 2016 released a strategy for global elimination by 2030 (i.e., 90% reduction in HCV transmission and 65% reduction in HCV-related mortality). The United States (US) National Academies of Sciences has deemed US elimination of HCV a feasible goal. HCV-Infected persons born during 1945-1965 are at greatest risk for HCV-related mortality. Certain strategies improve the HCV testing, care, and cure cascade and can reduce HCV-associated deaths. Provider education and adoption of clinical decision tools improve rates of HCV testing. Training and support of primary-care clinicians expand the workforce offering HCV services. Diagnosis of current HCV infection is improved by reflex testing of anti-HCV+ specimens for HCV RNA. Patient navigation services help persons begin and remain in care. At national and health-system levels, implementing policies and setting and measuring performance targets can improve quality of services. Issues with provider reimbursement for HCV treatment limit the number of persons treated through the Affordable Care Act and proposed changes might impact access to care. Creative solutions are needed for universal access to HCV treatment. Reducing US HCV transmission rate by 90% requires a targeted approach. Incidence is rising among persons who inject drugs (PWID); an increasing number of infants are born to HCV-infected mothers. Harm reduction services (e.g., clean injection equipment, drug treatment services) can prevent >70% of infections among PWID; HCV testing and treatment can enhance prevention. Access to these interventions is poor, particularly in areas with high HCV incidence. In the absence of an effective HCV vaccine, reaching elimination goals for transmission will require improved detection and investigation of transmission networks, increased availability of harm reduction services, affordable HCV therapies, and better evidence and capacity to deliver prevention services. Targeted intervention delivery to incarcerated and other vulnerable and marginalized populations is key to achieving elimination goals. With strong societal commitment and support for implementing comprehensive HCV prevention, testing, care, and treatment, HCV can be eliminated as a public health threat in the US.