Elimination of viral hepatitis C among drug users in the Czech Republic

Viral hepatitis C (VHC) is a major public health and epidemiological problem worldwide and in the Czech Republic. The World Health Organization (WHO) has therefore identified the elimination of hepatitis C virus by 2030 as an important public health target and urged Member States to develop a national HCV elimination strategy. The aim of the WHO is to stop the transmission of HCV and to provide everyone with access to prevention, treatment and care. Member States are to reduce new infections by 90% by 2030 and reduce HCV mortality by 65%. An important part of the strategy must be to prevent infection among injecting drug users through harm reduction services, testing and treatment of HCV.

In the Czech Republic, the incidence of chronic hepatitis C is estimated to be around 80,000, most of which (about 60%) are due to drug injection. Serious clinical end-points (cirrhosis, liver failure, hepatocellular carcinoma) usually occur within 20-30 years of infection. If patients are not identified and treated in time, the development of injecting drug use in the Czech Republic can be expected to have a significant impact of HCV epidemics on morbidity and mortality and increased health care costs in the next two decades.

With the estimated number of injecting drug users (IDUs) in the Czech Republic 44 thousand. (95% CI: 43–45 thousand), HCV seroprevalence of 35% (95% CI: 32–38%) and 70% of the transition to chronicity in the Czech Republic in 2017 can be estimated at 9.5 thousand. up to 12 ths. active IUDs with chronic HCV. Thousands more can be expected among former IDUs in addiction treatment or beyond.

The coverage of injecting drug users (IDUs) with harm reduction measures (needle and syringe exchange programs, opiate substitution treatment) is low to medium in the Czech Republic according to international standards. Without active search for HCV infection and immediate treatment of all former and active drug users with chronic HCV, it is not possible to achieve a significant reduction in HCV incidence and its consequences in the Czech population and to achieve the goals set by the WHO to which the Czech Republic subscribed. A set of measures aimed at prevention, screening, diagnosis, treatment and aftercare (prevention of reinfection) is proposed within the action plan. Its implementation is only possible if the elimination of HCV is recognized as one of the priorities of the key institutions and stakeholders active within the continuum of care and adequate resources for its implementation are provided. Another condition is a multidisciplinary approach, patient-focused approach and removal of barriers to access to care. Representatives of all key parts of the continuum of care were invited to discuss the preparation and implementation of the action plan.

The National Monitoring Centre for Drugs and Addiction (national focal point) has prepared an Action Plan for the Elimination of HCV among drug users in the Czech Republic, which includes a set of measures aimed at prevention, search, diagnosis, treatment and follow-up care. This Action Plan was approved by the Government Council for Drug Policy Coordination on 21 August 2019.