Fighting Hepatitis C: Expanding Access to Diagnosis and Treatment

Discovery of a breakthrough cure raised hopes of eradicating the virus. However, the disease still remains largely undiagnosed and untreated, especially in low- and middle-income countries. Approximately 50 million people suffered from chronic hepatitis C virus (HCV) infection in 2022 and 240,000 died.

Although progress has been made in making the cure available, HCV infections continue to rise among certain groups, such as people who inject drugs, who comprise 10% of those infected but account for 43% of new infections. People living with HIV are six times more likely to be HCV-positive; chronic liver disease is a major cause of death for people with HIV. Rural, displaced, marginalized, and poor populations are disproportionately affected by viral hepatitis.

Direct-acting antivirals have revolutionized HCV treatment, curing over 95% of infections in 12 weeks with well-tolerated medications. However, access to prevention, harm reduction, and health care services for at-risk populations is insufficient, with stigma, inequalities, criminalization, and other barriers hindering response efforts.

At Unitaid, we save lives by making new health products available and affordable for people in low- and middle-income settings. We identify innovative treatments and tools, help tackle the market barriers that are holding them back, and get them to the people who need them most – fast.

As one of the largest funders in the fight against HCV, we are supporting the global elimination targets through prevention, testing and treatment, with a focus on reaching the most marginalized and vulnerable populations.

Harm reduction programs minimize the risks of drug use through needle exchanges, safe injection sites, and opioid agonist therapy. Integrating HCV testing and treatment into programs that serve people who inject drugs is essential to meet the WHO 2030 HCV elimination targets. Working with partners, we are piloting the use of low dead-space syringes, which reduce the risk of transmitting blood-borne infections like HCV when needles are shared; long-acting opioid agonist therapy, which decreases the frequency and urgency to inject drugs; and HCV testing and treatment.

People living with HIV are at a higher risk of HCV, but many low- and middle-income countries use a siloed approach to disease management, so coinfections can go undiagnosed and untreated. Integrating HCV care into both HIV clinics and harm reduction programs reaches more people with vital care—saving lives, improving efficiencies and reducing costs.

Affordable, simple and reliable testing enables timely diagnosis, increases testing rates and facilitates quicker access to care and treatment. Together with partners, we have supported development of simpler tests, including rapid self-tests, and demonstrated how to use them in local health care facilities and by non-specialist staff in low-resource settings. This approach makes testing more accessible, particularly for marginalized and high-risk populations.

Before we began our work on HCV in 2015, the absence of quality-assured, cost-effective, and easy-to-use diagnostics meant testing was inaccessible to most people in low- and middle-income countries. We have dramatically simplified testing and improved the affordability of treatment, proving that diagnosing and treating HCV in lower levels of the health system is feasible and effective.

Our work has contributed to a nearly 40% decline in HCV-related deaths and a 30% decrease in the total number of people infected since 2015.

• Introduced simple-to-use, rapid tests. With evidence generated by Unitaid projects, WHO validated this approach in 2021 and quality-assured the first HCV self-test in 2024.

• Addressed intellectual property barriers to develop and enable use of affordable generic medicines and removed other access barriers to HCV treatment in low- and middle-income countries.

• Informed global policies and guidelines to better equip health care facilities to test and treat HCV.

• Supported policy change in several countries through advocacy for new HCV drugs and tools and community engagement.

Thanks to concerted global efforts, the tools to diagnose and cure HCV are now affordable and accessible in most countries. However, access gaps persist: only 1 in 5 people with chronic HCV infection have access to highly effective medicines. The fight against HCV requires more than just availability of diagnostics and treatments; it demands decisive action. Unlike HIV, tuberculosis, and malaria, there are no established international scale-up funding mechanisms to support the response to HCV. The primary funders of HCV programs are national governments, making our work to find more affordable tests and treatments even more critical.

With effective tools Unitaid's work has helped make available, several 'pioneer' middle-income countries have started to finance and scale up HCV care and develop plans in line with the WHO elimination goals, demonstrating that these targets can be reached.

Looking ahead, we are working to introduce innovative tools and further simplify treatment by supporting the development of a long-acting treatment that could cure hepatitis C with a single injection. By leveraging these tools, we can continue to make significant strides towards the elimination of HCV as a public health threat.