Treating children and adolescents with hepatitis C: policies and practices

The development of Direct Acting Antivirals (DAAs) has dramatically transformed the treatment of hepatitis C (HCV) infection and spurred the global movement to eliminate viral hepatitis by 2030. However, current levels of treatment coverage are insufficient to meet elimination goals. This thesis aims to investigate the treatment of children infected with hepatitis C, and to examine the policies and practices for their diagnosis, treatment, and care to inform the roll out of DAAs for paediatric treatment. This PhD comprises five studies: (i) a systematic review of DAA safety and effectiveness; (ii) a global review of national hepatitis policies; (iii) a global survey of DAA utilisation and availability, healthcare workers’ (HCWs) preferences and programmatic barriers to delivering paediatric HCV treatments; (iv) a national survey on policy-practice gaps and DAA uptake in Russia; and (v) analysis of DAA treatment outcomes and DAA uptake for HCV/human immunodeficiency virus (HIV) co-infected children and adolescents using real-world data from European HIV cohorts. Results from these studies show that although DAAs are safe and effective for treatment of HCV mono-infected and HCV/HIV co-infected children and adolescents, national HCV policies in most countries do not include recommendations on paediatric testing or treatment. Although HCWs are strongly in favour of treating children, they face barriers in delivering treatment which include absence of national guidelines supporting treatment, limited availability of DAAs, high cost, and lack of paediatric formulations. To achieve the ambitious elimination targets, it is essential to improve access to treatment for all, including the 3.26 million children and adolescents living with HCV. The barriers to service delivery identified here will help policy makers and implementers design interventions to scale up DAAs for children. Results will also contribute to development of treatment guidelines, especially filling the gap in evidence on DAA use for HCV/HIV co-infected children