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More action required on HCV

Prior to the Covid-19 pandemic and the remarkable breakthroughs seen in vaccinology, another virus was the centrepiece of recent medical innovation.

Within the past decade, direct-acting antivirals (DAAs) have revolutionised treatment of hepatitis C virus (HCV), making international elimination goals eminently achievable.

In theory, of course.

HCV largely affects marginalised sections of societies, with injecting drug use being the main mode of transmission in high-income countries.

A modelling paper published in Liver International in January reported progress made in the timing of HCV elimination in 45 high-income countries between 2017 and 2019.

The study, led by the Centre for Disease Analysis, projected that only 11 of the countries studied would meet the World Health Organisation HCV elimination targets by 2030.

This prompts an uncomfortable question. Would societies have travelled further in their elimination journey if the affected cohorts were middle-class self-advocates with greater access to media and politicians?

Ireland was not one of the countries identified as ‘on track’ in the modelling paper.

The HSE National Hepatitis C Treatment Programme (NHCTP) has done positive work since its inception in 2015, with DAA treatment rolled out to approximately 6,000 people as of April 2021.

A considerable annual budget has been accorded to the programme, largely ringfenced to cover drug costs. However, DAA prices have dropped considerably, it is understood, and it remains unclear why more funding cannot be channelled into fully resourcing the implementation of national screening guidance published in 2017.

Some clinicians in infectious diseases and hepatology say the more difficult-to-reach patients are simply not getting treated in time. And the consequences of this are devastating.

In April, Prof Jack Lambert, Consultant in Infectious Diseases at the Mater Hospital in Dublin, told this newspaper: “We still say there is a significant burden of people [with HCV] out in the community with advanced liver disease. I’d probably say 10-to-20 per cent of the patients we are seeing have advanced liver disease and the idea is to treat people before they get advanced liver disease.”

Community workers speak of a lack of information on the metrics used by the NHCTP to gauge progress; and an implacably slow rollout of community-based screening, testing, and treatment, with significant logistical and procedural barriers faced by GPs wishing to participate.

‘Geography’ is also playing a disconcerting role in treatment access, according to community workers.

As World Hepatitis Day approaches on 28 July, it is a time to remember the forgotten. A high-level commitment to addressing shortfalls in HCV treatment access would be an adequate start.

Editor Paul Mulholland is on annual leave.

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