An International Perspective on Using Medication-Assisted Therapy of Opioid Dependence to Improve Hepatitis C Virus Infection Prevention and Care for People Who Inject Drugs: Structural Barriers and Public Health Potential

Issue:People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Medication assisted treatment (MAT) of opioid dependence has the potential to aid the public health response to HCV by 1) serving as primary HCV prevention, 2) treating non-injection opioid dependent people who might otherwise transition to drug injection, and 3) serving as a platform for HCV services.

Description: We examined programmatic, structural and policy considerations relevant to using MAT to improve HCV control in 3 countries—the United States, Estonia and Viet Nam.

Lessons Learned: In each country a range of interconnected factors affects the use MAT as a component of HCV control. These factors include 1) that MAT is not yet provided on the scale needed to adequately address illicit opioid dependence, 2) inconsistent use of MAT as a platform for HCV services, 3) high costs of HCV treatment and health insurance policies that affect both MAT and HCV treatment access, and 4) the stigmatization of drug use.

Recommendations: The following appear to be important for controlling HCV transmission among PWID: 1) maintaining current HIV prevention efforts, 2) expanding efforts to reduce the stigmatization of drug use, 3) expanding MAT as part of a coordinated public health approach to opioid dependence, and HIV and HCV control efforts, 4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention. The global expansion of MAT and its use as a platform for HCV services should be both a feasible next step in the public health response to the HCV epidemic, and is likely to be critical in efforts to eliminate or eradicate HCV.