Position Paper November 2013

Hepatitis C Education, testing, care and treatment for People who Use Drugs
www.anpud.org
Introduction The Asian Network of People who Use Drugs (ANPUD) is a community based network of people with a history of drug use in Asian countries. ANPUD responds to issues that affect the lives of people who use drugs (PUD) in the Asia region, ensuring the voice of the people affected is heard, and advocating for the health and human rights of our community. Issue Over 4.5 million people are estimated to use drugs in Asia. Of the people who have injected drugs, approximately thirty percent are living with HIV1, and sixty percent are living with hepatitis C2. In contrast, less than one percent of people who inject drugs are estimated to have access to adequate health, social and legal services3. Hepatitis C is a preventable and treatable blood borne virus that disproportionately affects people who inject drugs. Co-infection with HIV adds additional complications to the treatment and care of people living with both viruses such as drug and treatment interactions, increased disease progression, and reduced treatment outcome success. A sustained international response to HIV has meant that many more people living with HIV, including some with a history of drug use, now have access to anti-retroviral treatment. However, in the Asia region, hepatitis C services are rare. People who have been living with hepatitis C for many years, or who are co-infected with HIV and need specialised HIV, are experiencing the negative and sometimes fatal effects of the hepatitis C virus without access to quality, affordable hepatitis C testing, diagnostics and treatment. Education of PUD and health service providers about hepatitis C is extremely limited. Access to hepatitis C testing and diagnostics is also unavailable or unaffordable for most PUD. Research conducted by ANPUD in India, Indonesia, Malaysia and Nepal found most PUD received information about hepatitis C from their peers or health services. However, none of the health service providers surveyed provided hepatitis C treatment, and most didnt know where testing and treatment was available or how much it cost. Although eighty six percent of the PUD surveyed had heard of hepatitis C, most gave incorrect answers to questions about hepatitis C transmission4. It is essential that PUD networks are supported to learn and educate their communities about hepatitis C, and that health systems are similarly strengthened.

Mathers, B.M., et al., 2010. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. The Lancet. DOI:10.1016/S0140-6736(10)60232-2
2

Shephard, C.W., et al., 2005. Global epidemiology of hepatitis C virus infection. Lancet Infectious Diseases; 5: 588-76.
3 4

Mathers, B.M., et al., 2010.

Asian Network of People who Use Drugs, 2011. Barriers to hepatitis C diagnosis, management and treatment among people who inject drugs in four Asian countries: A community led study in India, Indonesia, Malaysia and Nepal.

In Asian countries where hepatitis C testing, diagnostics and treatment are available, the costs for these services are extremely high. The six to twelve month treatment for hepatitis C costs up to twenty thousand US dollars, a cost that is significantly out of reach of most people. The lack of affordable hepatitis C testing and treatment decreases the ability of states as well as individuals to adequately understand the extent of the problem, or to effectively address it. These factors have a significant effect on the lives of PUD, their families and their communities. As new medications have recently been released and continue to be developed, it is crucial health systems are strengthened, health service providers are trained in their use, and PUD networks are resourced to develop communication strategies our communities of PUD. It is also equally necessary that all Asian country governments work with PUD communities to these new medications are available at an affordable price, ensuring Asian PUD have access to the best available hepatitis C treatment. Position statement ANPUD believes that PUD have a right to the highest standard of health and human rights. We believe every country in the Asia region should be working to provide comprehensive hepatitis C prevention, treatment, diagnostics and care for PUD. Prevention of hepatitis C transmission through peer education and provision of new injecting equipment including low dead space syringes is essential to reducing the epidemic levels of hepatitis C in our PUD community. PUD networks need to be resourced to provide peer education, to protect and care for its members. We believe the current hepatitis C testing, diagnostics and treatment services available in Asia are inadequate and far too expensive. We believe highest quality hepatitis C testing, diagnostics and treatment should be available to anyone who needs it at an affordable price, and in a non-judgemental environment. We believe the meaningful involvement of PUD is a necessary component of responding to the hepatitis C epidemic that has been affecting our community for many years. We believe addressing hepatitis C is also an important aspect of the response to hepatitis C and HIV co-infection in our community. Addressing the hepatitis C epidemic will benefit not just our PUD community but everyone. Recommendations The guiding principle of ANPUD is that the meaningful involvement of PUD is integral to all recommendations in this position statement. 1. A commitment by all governments in Asia to implement hepatitis C prevention services including: a. Adequate coverage of best quality needle and syringe programs including provision of low dead space syringes and other injecting equipment that can act to transmit the hepatitis C virus; Sufficient coverage of opioid substitution treatment in line with international standards; Peer education by and for PUD; Integration of hepatitis C testing, diagnostics and treatment into existing HIV services.

b. c. d. 2.

A commitment to develop national treatment guidelines in all countries, informed by and developed with our PUD community, and based on best available guidelines to ensure highest quality standards of treatment for people living with hepatitis C; A commitment by all governments in Asia to implement free or affordable hepatitis C testing; A commitment by all governments to work with our PUD community to negotiate price reductions for hepatitis drug treatments; A commitment by all governments in Asia to implement free or affordable, best available standard hepatitis C diagnostics and treatment for people living with hepatitis C; Development of systems to gather and use data in all Asian countries through the development of: a. b. Peer-led testing of hepatitis C in harm reduction services; Other national systems to commence and increase access to testing, national surveillance systems, data management and research to improve understanding of burden of disease, inform effective advocacy and ensure governments and PUD communities can respond effectively to this major public health threat.

3. 4. 5. 6.