The promise of treatment as prevention for hepatitis C: Meeting the needs of people who inject drugs?

• We critically appraise the promise of HCV treatment as prevention (TasP) for PWID.
• TasP has potential to be a powerful HCV treatment access advocacy tool for PWID.
• There is a need to be cognisant of and address PWID community concerns about TasP.
• Enhanced OST and NSP are critical human rights and TasP interventions.
• Community engagement and enabling interventions are pivotal for TasP success.

Treatment as prevention (TasP) is a concept common to the HIV sector. In this commentary we draw on the literature addressing HIV and HCV TasP, alongside qualitative HCV research, to critically appraise the promise of TasP for HCV and assess the needs of PWID in the future of HCV care. With the advent of highly effective direct-acting antiviral HCV treatments, TasP is now under consideration for HCV. A growing body of literature documents numerous social structural barriers to HCV treatment access and uptake for PWID, among whom HCV is highly prevalent. Yet these barriers – and suggestions for surmounting them – are rarely included in emergent literature on HCV TasP. Although HCV TasP has important advocacy potential for increasing treatment access among PWID, critical reflection on its implications are warranted. We outline potential limitations of TasP for HCV and the conditions under which it might be optimised. We argue that HCV treatment as a prevention strategy can only be realisable in a context of enhanced harm reduction access, meaningful community engagement, and enabling environment interventions informed by the needs and perspectives of PWID.