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The successful scale-up of direct-acting antiviral hepatitis C treatments will benefit from concerted investments in implementation science

  • Rod KnightEmail author
  • Mint Ti
Commentary

Abstract

The introduction of highly efficacious direct-acting antiviral (DAA) treatment therapeutics presents new opportunities to both directly reduce chronic hepatitis C virus (HCV) prevalence and prevent the onward transmission of HCV. To achieve the equitable scale-up of DAA interventions at the population level, however, reductions in HCV incidence and prevalence must be achieved among entire populations of people living with HCV—all in “real-world” conditions. In this commentary, we describe five problem areas that will benefit from new investments in implementation science in order to inform the scale-up of DAA interventions: (1) New evidence is needed to optimize the integration of DAA treatments into generalist models of care; (2) DAA scale-up needs to be adaptive to the needs of highly diverse and large populations living with HCV who will benefit from DAA interventions; (3) we need to do better at measuring and responding to features of implementation context; (4) costs need to be explicitly assessed in “real time”; and (5) new research-community-practice partnerships are needed to inform evolving HCV testing, treatment and prevention guidelines, policies, and programs. We offer solutions to address these problem areas, with an emphasis on describing how investments in implementation science can address each of these challenges “head on.”

Keywords

Hepatitis C Implementation science Scale-up Treatment 

Résumé

L’introduction des traitements thérapeutiques très efficaces d’antiviraux à action directe (AAD) présente de nouvelles opportunités pour réduire directement la prévalence chronique du virus de l’hépatite C (VHC) et pour prévenir la transmission ultérieure du VHC. Cependant, afin d’atteindre une mise à l’échelle équitable des interventions d’AAD au niveau de la population, des réductions de l’incidence et de la prévalence du VHC sont nécessaires au sein de la population entière des personnes vivant avec le VHC et ce, en tenant compte des conditions réelles. Dans ce commentaire, nous décrivons cinq problématiques qui bénéficieront de nouveaux investissements en science de la mise en œuvre pour informer la mise à l’échelle des interventions d’AAD : (1) De nouvelles données scientifiques sont nécessaires pour optimiser l’intégration des traitements de AAD dans les modèles de soins généralistes; (2) La mise en place à grande échelle doit être adaptée aux besoins des diverses populations qui vivent avec le VHC et qui bénéficieront des interventions d’AAD; (3) Nous devons améliorer nos mesures et nos interventions dans le contexte de la mise en œuvre; (4) Les coûts doivent être évalués de façon explicite et en temps réel; et (5) De nouveaux partenariats entre les chercheurs, la communauté et les professionnels de la santé sont nécessaires pour informer le dépistage, les directives de traitement et prévention du VHC, les politiques et les programmes. Nous proposons des solutions pour répondre aux problèmes soulignés, en mettant l’accent sur la façon par laquelle les investissements en science de la mise en œuvre peuvent adresser chaque défi.

Mots-clés

Hépatite C Science de la mise en œuvre Mise à l’échelle Traitement 

Notes

Acknowledgements

Knight and Ti  are supported by Michael Smith Foundation for Health Research Scholar Award. US NIH Grant Number: 1R01DA043408-01.

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Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  1. 1.University of British ColumbiaVancouverCanada

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