Some observations for those drafting hepatitis C policy: Pricing of DAAs a barrier to access but HCV treatment has prevention as well as individual benefits and a call for drug policy reform.

There has been a considerable level of optimism at the International Network of Hepatitis in Substance Users conference in Munich today. There is a blossoming of new drugs to treat hepatitis C and they appear very effective over shorter durations than conventional therapy. The new DAA, those currently listed and those on the horizon or still in trial are competing for >90% sustained virological responses with some claiming  up to 100% in one of more genotypes. A number of presentations demonstrated that with support substance users can manage and complete treatment.

But the undercurrent to this meeting has been the issue of cost. Europe is reeling from the financial crisis and austerity measures. The cost of these new compounds is seen as prohibitive in developed economies, let alone middle and developing country settings. We have seen this in Australia with the listing of the first two DAAs. How we approach this issue is not clear, but it is likely that patents, trade agreements and intellectual property issues are likely to come under increasing scrutiny.

Restricting access to HCV treatment in people who use drugs is not supported by the science presented at this meeting and treatment is effective and achievable at a similar rate to that among non-drug users. The concept of treatment as prevention was raised by Natasha Martin from the University of Bristol and even modest treatment uptake has prevention benefits in her modelling. Michel Kazatchkine, reviewed the findings of the Global Commission on Drug Policy which has highlighted the futility of the war on drugs and its negative effects on health. The Commission has recently recommended harm reduction and treatment and Michel called for investment in health rather than the war on drugs as we move toward the 2016 UNGASS.

Treatment as prevention in hepatitis C has not really received much consideration yet in Australia. It was debated here and is emerging as an important concept in durable HCV management. As in HIV, it seems we must be exploring the role that treatment will have in preventing new HCV transmission. The review of the hepatitis C strategy provides an opportunity for exploring this issue further and modelling of the prevention effects of treatment should be included in the new National Hepatitis C Strategy.