Theme: Models of Care Year: 2025
Background:
Bangladesh was an early adopter of harm reduction (HR) measures in Asia, initiating programs in 1998. Despite a well‑established HR program, treatment for hepatitis C virus (HCV) among People Who Inject Drugs (PWID) remained missing, posing a significant health risk. To address this gap, a pilot initiative was launched in 2023 under the Global Fund NFM3 grant to diagnose and treat HCV infections among HIV‑positive PWID. The objective was to assess feasibility and inform future service expansion.
Description:
HR services for PWID in Bangladesh operate across 31 districts through drop‑in centers and peer‑led outreach. Three districts were selected based on epidemiological significance and availability of HCV confirmatory testing (HCV‑RNA). The pilot targeted 740 PWID receiving antiretroviral therapy (ART). A guideline outlining site selection, staff responsibilities, eligibility criteria, referral pathways, and follow‑up mechanisms was developed. Advocacy efforts engaged the Centre for Disease Control and the Network of People Who Use Drugs (NPUD) to facilitate government support for HCV management.
Effectiveness:
Screening was conducted for 704 of the 740 HIV‑positive PWID, identifying 288 (40.91%) with HCV antibodies. Confirmatory HCV‑RNA testing of 177 samples found 144 (81.36%) positive cases. Direct‑acting antiviral (DAA) therapy with Sofosbuvir/Velpatasvir was initiated for 131 individuals: 116 completed treatment, while 15 discontinued. SVR testing was conducted for 111 participants, with 87 (78.38%) achieving viral clearance and 24 remaining HCV‑positive. The high treatment completion rate underscores the feasibility of integrating HCV treatment into HR services.
Conclusion and next steps:
The pilot demonstrated the feasibility of integrating HCV treatment into HR services for PWID. Lessons learned informed service scale‑up under the Global Fund GC7 grant. Given the complexities of HIV and HCV co‑infection management, WHO guidelines were followed with expert consultation from tertiary care facilities. The government of Bangladesh planned to expand this model to enhance HCV care among PWID.