Module 10: Treatment quality, stigma and discrimination - section 5

In this document:

Guidelines on integrated HCV treatment for drug users

Activity: Information with group discussion
Section Time: Approximately 10 minutes

This activity highlights current guidance on HCV treatment for PWID.

Show Slide 10.10 (Current guidance on HCV treatment for IDUs) :


Points to emphasise:

  • Discuss this and next slide with reference to HIV/HCV co-infection
  • Raise the question of whether these may sometimes help support arguments regarding treatment for HCV alone.
  • Note: In the World Health Organisation document ‘Hepatitis C’ (2002), “Current intravenous drug abuse” is listed under “Contraindications to interferon therapy for chronic hepatitis C”. Hepatitis C (2002) World Health Organisation. Besides an argument that later guidance supersedes this, under publication details it says “This document is not a formal publication of the World Health Organization (WHO) ” and “The views expressed in documents by named authors are solely the responsibility of those authors”, which may allows its authority to be challenged.

Show Slides 10.11 and 10.12 (Current guidance on HCV treatment for IDUs) :



Points to emphasise:

  • ‘AIII’ is the grading scored by the evidence and means there is: ’A’  “Both strong evidence for efficacy and substantial clinical benefit to support [the] recommendation”; and, ‘III’ – [The] evidence [is] from opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committee.”
  • The key point to emphasise is that ‘A’ is the strongest possible recommendation that can be made, which means that a lot of weight should be attached to the recommendations. This may be useful information that can support advocacy efforts.  
Supporting content:

Others European guidelines such as: Scottish Intercollegiate Guidelines Network (2006) ‘Management of hepatitis C: a national clinical guideline’, say “Current injecting drug users infected with HCV should not be excluded from consideration for HCV clinical management, including antiviral therapy, on the basis of their injecting status.”

If the forthcoming EASL Clinical Practice Guidelines for “Management of Hepatitis C Virus Infection” have been published they are likely to supersede the recommendations in Slide 10.11 and 10.12.

Show Slide 10.13 (Current guidance on HCV treatment for IDUs (3)) :


Points to emphasise:

  • Discuss these as one of the most recent, published, authoritative guidelines regardless of their origins outside of Europe.
  • Explain that the ‘Class IIa, Level C’ grading means that the strength of recommendation is intermediate i.e. the “weight of evidence/opinion is in favor of usefulness/efficacy” and the level of evidence is in the weakest category i.e. “Only consensus opinion of experts, case studies, or standard-of-care”.
  • For advocacy purposes, it can be argued that implementing these recommendations is supported by the evidence; however; people may argue that the evidence is not sufficiently strong.
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