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	Eliminating HCV " Test & Treat" - HCV is a Disease of the Marginalized: homeless, IDUs, immigrants, African-Americans, Latinos       "Treatment as Prevention" which I think is a great strategy as way to promote HCV discussion in the context of being a public health epidemic & how we can address this, as in HIV "Test & Treat" is a concept I have promoted for years in HCV, and this is a good way to capture attention from federal & local govts.   Another key point often overlooked as it was regarding HBV is immigrant populations. Awareness & screening programs culturally appropriate to each immigrant population will be important. HCV is often contracted in one's homeland & brought with one when they immigrate, and of course NYC & the USA has many diverse large immigrant populations. NYC is a magnet for diverse immigrant populations who come from countries where HCV is prevalent. In NYC there are 1 million from China often congregated in certain neighborhoods, there are large populations from Russia & eastern europe, India, Pakistan and that peninsula, from the more easter Asian area, from Africa & South America. This is true in many cities around the USA including LA & Miami, and New Mexico. We may have 1 million HCV+ immigrants currently in the USA.   In addition the homeless population is often overlooked, where HCV prevalence is way higher than the general population, lets remember many IDUs and substance abusers are homeless, so this also must be addressed, who will treat them & where & screening in this population arekey.   IMPACT OF NEW DAA-CONTAINING REGIMENS ON HCV TRANSMISSION AMONG INJECTING DRUG USERS (IDUS): A MODEL-BASED ANALYSIS (ANRS 12376)...."Test & Treat", Eliminating HCV...... http://www.natap.org/2014/EASL/EASL_87.htm   In fact, yesterday at the NY Research Consortium meeting this was a key topic of discussion as I mentioned in discussions how 50% of HCV-infected in the USA have a history of IDU as the CDC has reported. HCV could be eradicated in the USA & globally if there were resolve to do what is necessary.   HCV Could be a "Rare Disease" by 2026, "1-time HCV screening for all/test & treat"..... need for more aggressive screening strategies and higher treatment capacity.....1-time universal screening - new study projects.......http://www.natap.org/2014/HCV/080614_01.htm   In a published study by the CDC in May 2014 in PLOS ONE called Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections: "we estimated that persons who ever injected drugs comprised 2.6% (CI: 1.8%-3.3%) of the U.S. population......we estimate that approximately 774,434 adults and adolescents (range: 494,605-1,054,263) injected drugs in the past year in the United States......This represents approximately 6,612,488 million PWID (range: 4,583,188-8,641,788) aged 13 years or older in 2011.......Although PWID comprise 3% or less of the U.S. population, they account for 22% of all persons living with HIV infection.....HCV Infection Rate among PWID in the U.S: The prevalence rate of HCV infection among PWID aged 40-65 years was 43,126 per 100,000 PWID (CI: 34,024-58,875)."   In order to address "Treatment As Prevention" a key element is to address the needs of IDUs and reaching out to this community regarding screening, linkage to care & access to care in particular because there is a severe limitation on the most marginalized from this group because they are difficult to treat & there are many barriers to address. There is a shortage of treaters willing to treat the most difficult or marginalized of this patient population; many clinicians do not want to treat them or are not trained to treat them, so there is a shortage in the numbers of places where they can be treated. As well, we need community-based, neighborhood based awareness & local screening sites where they can be linked to care & treatment, this needs to change if treatment as prevention is to be promoted successfully.   New Published Study Discusses Global Epidemiology of PWID, People Who Inject Drugs, & HIV & HCV Prevalence....... http://www.natap.org/2014/HCV/062314_04.htm   Linkage To Care for IDUs, a Barrier: http://www.natap.org/2014/HCV/080814_03.htm   HCV is A Disease of the Marginalized- IDUs, homeless: http://www.natap.org/2014/HCV/052814_02.htm   New antiviral treatment could significantly reduce global burden of hepatitis C - New Study   Authors: Natasha K Martin1,2, Peter Vickerman2, Jason Grebely3, Margaret Hellard4, Sharon J Hutchinson5,6, Viviane D Lima7, Graham R Foster8, John F Dillon9, David J Goldberg5, Gregory J Dore3, Matthew Hickman http://www.natap.org/2013/HCV/051313_08.htm   Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations.......http://www.natap.org/2012/HCV/011212_03.htm   Hepatology January 2012 Natasha K. Martin,1,2 Peter Vickerman,1,2 Alec Miners,2 Graham R. Foster,3 Sharon J. Hutchinson,4,5 David J. Goldberg,4 and Matthew Hickman1   Eradication of hepatitis C infection: The importance of targeting people who inject drugs...... http://www.natap.org/2014/HCV/012414_04.htm "To achieve eradication, public health efforts must focus on PWID, the key drivers of HCV transmission....Prevention of HCV transmission is critically important for HCV eradication.....PWID are highly marginalized and few receive HCV treatment despite increasing evidence that treatment works.....Highly effective and tolerable HCV therapies will make treatment as prevention feasible....An interferon-free 12-week DAA regimen with single daily dosing and over 90% cure is a real possibility"   Combination Interventions to Prevent HCV Transmission Among People Who Inject Drugs: Modeling the Impact of Antiviral Treatment, Needle and Syringe Programs, and Opiate Substitution Therapy Natasha K. Martin, Matthew Hickman, Sharon J. Hutchinson, David J. Goldberg, and Peter Vickerman Combination Interventions to Prevent HCV Transmission Among People Who Inject Drugs: Modeling the Impact of Antiviral Treatment, Needle and Syringe Programs, and Opiate Substitution Therapy   [PDF]Download the PDF here - NATAP   www.natap.org/.../HCV_reinfection_incidence_and_treatment_outcome.... by TCS Martin - 2013 - Cited by 16 - Related articles   May 21, 2013 - HCV reinfection incidence and treatment outcome among HIV-positive MSM in London. Thomas C.S. Martin a. , Natasha K. Martin b,c. PDF]Download PDF - London Joint Working Group www.natap.org/2011/HCV/PIIS0168827.pdf   by NK Martin - 2010 - Cited by 83 - Related articles Natasha K. Martin1,2,*. , Peter Vickerman1,2, Graham R. Foster3, Sharon J. Hutchinson4,5,. David J. Goldberg4, Matthew Hickman1. 1Department of Social ...   Prevention and Management of Hepatitis C Virus Infection Among People Who Inject Drugs: Moving the Agenda Forward   All PDFs attached   Clinical Infectious Diseases Volume 57 suppl 2 August 15, 2013 http://www.natap.org/2013/HCV/072613_01.htm           View Older Articles   Back to Top   www.natap.org