Report: Science over Stigma: The Public Health Case Against HCV Treatment Sobriety Restrictions

In response to the introduction of effective, short-course, curative hepatitis C (HCV) treatments, shifting HCV trends nationwide, and calls for universal access to treatment, NASTAD has recently released Science over Stigma: The Public Health Case Against HCV Treatment Sobriety Restrictions,which explores the impact of private and public insurance sobriety requirements that are barriers to HCV treatment.

Science over Stigma highlights the discriminatory, biased, and unnecessary practice of requiring a period of sobriety prior to receiving HCV curative treatment. HCV kills more people than all other 60 infectious diseases tracked by the Centers for Disease Control and Prevention (CDC) combined. Among people who inject drugs (PWID), the prevalence of HCV is a staggering 70% and while clinical recommendations suggest that everyone diagnosed should receive curative treatment, only a fraction of these individuals are currently eligible due to onerous and discriminatory sobriety restrictions. To achieve the goal of ending the HCV epidemic, stop the spread of the disease, and improve community health outcomes, it’s critical to reverse these devastating policies.

Key findings of the report include:

  1. People who use drugs can adhere to treatment – Eligibility protocols based on sobriety are based on outdated, biased assumptions about the ability of people who use drugs to adhere to complex medical regimens. This assumption has been discredited by an Australian HCV study that indicated a similar adherence rate between drug users and non-drug users alike.
  2. Risk of re-infection among PWID is minimal – Several studies have shown that the risk of reinfection is low, especially when coupling HCV treatment with other harm reduction interventions such as medication-assisted treatment and syringe services programs (SSPs).
  3. Offering HCV curative treatment reduces the amount of transmissible disease within communities most affected – By increasing testing, treatment, and coordinated linkage to care, HCV prevalence will be reduced within communities at high-risk of exposure to the virus such as PWID. Offering this care in conjunction with SSPs reduces HCV, HBV and HIV risk.
  4. Treatment of HCV among PWID is cost-effective and demonstrates the need for accessible, equitable insurance for all –  The cumulative cost of treating HCV in America is estimated at $6.5 billion currently and projections will peak in 2024 at $9.1 billion. Prevention through SSPs and curative treatment is far less costly than the overall burden of untreated chronic care for people living with HCV.

 NASTAD envisions a time when new HCV infections in the United States are rare, and when they do occur, every person, regardless of substance use status, age, gender, race/ethnicity, sexual orientation, gender identity, disability, socio-economic status, incarceration status or geographic location, will have access to quality, affordable health care including comprehensive screening, care, and treatment leading to cure, without stigma and discrimination.

For more information on NASTAD’s document Science over Stigma, their hepatitis or drug user health programs and policy activities, please contact Chris Taylor, Senior Director, Hepatitis or Laura Pegram, Manager, Drug User Health.

About Kim Rodgers

Kim Rodgers serves as a Communications Specialist at NACCHO. Her work includes promoting local health departments' best practices, as well as partner tools and resources, in infectious disease and preparedness through NACCHO's communications channels, storytelling, and outreach to various audiences.

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