Leveraging opportunities for treatment/user simplicity (LOTUS): Navigating the current treatment landscape for achieving hepatitis C virus elimination among persons who inject drugs

All-oral, direct-acting antivirals can cure hepatitis C virus (HCV) in almost all infected individuals; yet, many individuals with chronic HCV are not treated, and the incidence of acute HCV is increasing in some countries, including the United States. Strains on healthcare resources during the COVI...

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Bibliographic Details
Published in:	Journal of viral hepatitis Vol. 31; no. 6; pp. 342 - 356
Main Authors:	Sulkowski, Mark S, Martinez, Anthony, Tyson, Gia L, Scholz, Kathleen, Franco, Ricardo A, Kohli, Anita, Julius, Susan F, Deming, Paulina, Fink, Scott A, Lynch, Keisa, Roytman, Marina, Stainbrook, Tuesdae R, Turner, Marshe D, Viera-Briggs, Matthew, Ramers, Christian B
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-06-2024
Subjects:	Acuity Antiviral agents Antiviral Agents - therapeutic use COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control Disease Eradication - methods Health care Hepacivirus - drug effects Hepatitis C Hepatitis C - drug therapy Hepatitis C - prevention & control Hepatitis C, Chronic - drug therapy Humans SARS-CoV-2 Substance Abuse, Intravenous - complications hepatitis C persons who inject drugs (PWID) direct‐acting antivirals
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Summary:	All-oral, direct-acting antivirals can cure hepatitis C virus (HCV) in almost all infected individuals; yet, many individuals with chronic HCV are not treated, and the incidence of acute HCV is increasing in some countries, including the United States. Strains on healthcare resources during the COVID-19 pandemic negatively impacted the progress toward the World Health Organization goal to eliminate HCV by 2030, especially among persons who inject drugs (PWID). Here, we present a holistic conceptual framework termed LOTUS (Leveraging Opportunities for Treatment/User Simplicity), designed to integrate the current HCV practice landscape and invigorate HCV treatment programs in the setting of endemic COVID-19: (A) treatment as prevention (especially among PWID), (B) recognition that HCV cure may be achieved with variable adherence with evidence supporting some forgiveness for missed doses, (C) treatment of all persons with active HCV infection (viremic), regardless of acuity, (D) minimal monitoring (MinMon) during treatment, and (E) rapid test and treat (TnT). The objective of this article is to review the current literature supporting each LOTUS petal; identify remaining gaps in knowledge or data; define the remaining barriers facing healthcare providers; and review evidence-based strategies for overcoming key barriers.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	1352-0504 1365-2893
DOI:	10.1111/jvh.13927