However, from a more global point of view, such programs remain isolated examples of best practice in their respective regions and have, so far, had no relevant effect on the epidemic. Many Western countries show similar hepatitis C prevalence levels to the ones in Melbourne and Vancouver,[2]

with similarly low levels of treatment uptake rates, but with reasonably high coverage of primary prevention measures. To achieve nationwide treatment uptake rates among PWID that relevantly affect prevalence, groundbreaking changes in the currently inefficient HCV care system for this vulnerable population are urgently needed. First, and easiest to achieve: treating patients irrespective of their liver fibrosis stage, which is, in effect, treatment as primary prevention. Today, in many countries, fibrosis stage of at least F2 is a prerequisite

to obtain antiviral treatment. Second, a paradigm shift concerning reinfection must be made: Risk signaling pathway of reinfection is one of the most mentioned reasons why PWID are not treated. Looking closely at the model of Martin et al., risk of reinfection actually becomes an indication for BI-6727 treatment because people at risk of reinfection are also the most likely to further spread the virus. From a public health perspective, treating those at high risk of reinfection should be a priority and, if indicated, they should be treated repeatedly. Similar model calculations for dual-combination therapies with pegylated IFN and ribavirin have shown that this is a cost-effective approach and, in many settings, even more cost-effective than treating patients without intravenous drug use.[3] Third, a relevant scale-up of treatment among PWID is impossible without massively reducing the barriers to hepatitis care. Low awareness, as well as low hepatitis and addiction literacy, among healthcare professionals and discrimination and stigmatization of drug users are all major barriers for PWID to access HCV care.[4] Many of those barriers are a result of the criminalization medchemexpress of drug use,[5] one of the taboos that need to be broken. The

global war on drugs of today is hindering effective public health measures for PWID and therefore fueling the HCV and HIV epidemic in this population. Decriminalizing drug use would therefore be an important step toward eliminating hepatitis C (Fig. 1). As discussed by Martin et al.,[1] another taboo that has to be looked at is the highly limited access to HCV standards of care all over the world resulting from financial restrictions. The cost of today’s standard-of-care HCV treatment is prohibitively expensive for middle- and low-income countries. Even in Western European countries, access to triple therapies is restricted because of the exorbitant cost of the medication. Prescriptions of IFN-free HCV treatment regimens at similarly high prices will inevitably be restricted by health authorities. High tolerability of those regimens will bring the potential of high applicability.