Towards the Elimination of Hepatitis C in the United States

Abstract

The emergence of effective direct-acting antiviral (DAA) agents has reignited discussion over hepatitis C elimination potential in the United States. Eliminating hepatitis C will require a critical examination regarding technical feasibility, economic considerations, and social/political attention.

Tremendous advancement has been made in recent years with the availability of sensitive diagnostic tests and highly effective DAAs capable of achieving sustained viral response (SVR) in more than 95% of patients. Eliminating hepatitis C requires escalating existing surveillance networks to identify and respond to new epidemics. Basic prevention strategies such as community based outreach and education, testing and counseling, clean syringe and needle exchange programs, safe injection sites, opioid substitution therapies, and mental health services must be scaled up and adapted to target high risk groups.

Although costs of DAAs have raised budget concerns for hepatitis C elimination, studies have shown that eliminating hepatitis C will produce a savings of up to 6.5 billion USD annually along with other intangible benefits such as work productivity and quality of life. Simulation economic models and meta-analyses suggest that all adults should be screened for hepatitis C, but special efforts must focus on high risk populations.

There is growing recognition that social and political factors are at least as important as technical feasibility and economic considerations. Due to lack of promotion and public awareness, HCV elimination efforts continue to receive inadequate funding. Social stigma continues to impede meaningful policy changes. Eliminating hepatitis C from the U.S. is possible but it will require a sustained national commitment and strong political leadership. This article is protected by copyright. All rights reserved.

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