Hepatitis C prevention at a crossroads: Insights from harm reduction

Injection drug use is the leading cause of new hepatitis C infections in the United States and a major driver of the epidemic worldwide. Strategies that have proven effective in reducing HIV transmission through injection drug use – including syringe access, drug treatment, and outreach and education – have each had limited impact on hepatitis C rates among drug injectors, and there currently is no vaccine to prevent infection. Annual hepatitis C incidence rates among injectors range from 10% to 40%, and overall prevalence exceeds 50% among people who have injected drugs for at least five years. Recent research findings provide new insights into social and structural factors which mediate hepatitis C risks among injectors, pointing towards the need for a multimodal package of complementary prevention interventions. An effective package of public health interventions to prevent hepatitis C should include at a minimum greater access to sterile syringes and drug treatment, peer network-based education and testing strategies, anti-stigma efforts, and initiatives to address structural and environmental risk factors. The presentation will review the latest epidemiologic data and understanding of risk factors for injection-related transmission of hepatitis C, explore barriers and gaps in effective hepatitis C prevention, and describe promising evidence-based approaches to implementing a comprehensive hepatitis C prevention package. The presenter will discuss these approaches in the context of new recommendations from the Institute of Medicine report on viral hepatitis and liver cancer.