How to eliminate hepatitis C between people who inject drugs in community services and prisons in Catalonia

Abstract

Hepatitis C; People who inject drugs: Direct-acting antivirals

Antivirals d'acció directa; Hepatitis C; Persones que s'injecten drogues

Antivirales de acción directa; Hepatitis C; Personas que se inyectan drogas

The Spanish National Health System, with devolved powers to autonomous communities such as Catalonia, faces significant challenges in controlling viral infections like hepatitis C (HCV) among vulnerable groups, particularly people who inject drugs (PWID), where prisons serve as crucial intervention sites. Catalonia's health authorities have implemented strategies to combat HCV, including direct-acting antiviral (DAA) treatments and harm reduction programmes within both community and penitentiary settings. However, substantial barriers persist in achieving full treatment uptake and clearance among PWID subpopulations.

This review aims to discuss the Catalonia's current HCV programmes and explores intervention proposals needed to achieve WHO elimination targets. Catalonia has implemented a comprehensive HCV plan, particularly targeting PWID, that has proven effective through enhanced screening, universal treatment access, and harm reduction, though structural and social barriers remain due to fragmented health and social systems.

Advancing towards HCV elimination requires strengthened inter-organisational coordination, integrated social and health services, simplified care pathways, enhanced screening, professional training, targeted research, measurable goals, culturally appropriate and participatory prevention strategies, and a comprehensive, people-centred approach. This is particularly important in prisons, where universal screening, adapted caring processes, harm reduction, and opioid substitution treatments (OST) are essential. Considering the social determinants of health perspective, it is essential that policies and programs are structured to reduce structural inequities and vulnerabilities, thereby promoting equity in both access to prevention, care, treatment, and health benefits across all population groups, particularly those most affected.

Part of this study (translation) was supported by Gilead under Grant award: Free C, Hepatitis C treatment in prisons and consumption rooms (Gilead and Asociación Española para el Estudio del Hígado 2023).