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Historic models of hepatitis C treatment have not been suitably adapted for people who inject drugs (PWIDs). With the availability of highly effective direct acting antivirals (DAAs) and the possibility to eliminate hepatitis C as a public health threat, there is an urgency to improve treatment provision and uptake among PWID. This commentary explores the role of needle and syringe programs (NSPs) in providing hepatitis C treatment to PWID through an exploration of Positively Hep, a peer-referral, incentive-based project in Sydney, Australia. Positively Hep uses peer-networks to engage clients and introduce them to hepatitis C education, screening, and treatment. Within the first 26 months of operation, Positively Hep has provided education about hepatitis C and DAA treatments to 326 individuals, and has tested 145 people, 44% (n = 64) of whom have tested positive. Of these individuals, 21 (33%) have begun treatment, and 18 (28%) have successfully completed treatment. Positively Hep highlights the benefits of having trustworthy, timely, convenient, and client-friendly services to engage PWID and support them throughout hepatitis C treatment. This commentary is intended to prompt discussion about incorporating hepatitis C treatment into NSP service delivery, which could increase treatment uptake among PWID and support progress toward elimination targets. [ABSTRACT FROM AUTHOR]

Direct-Acting Antiviral (DAA) treatments for hepatitis C have been widely promoted by health promotion professionals and medical clinicians as being 'side-effect free'. In this paper, we draw on data that troubles this approach. We used a mixed method design to collect data from people who inject drugs, and who were DAA treatment naïve, in New South Wales, Australia. We describe knowledge about and perceptions of DAA treatment. We found that concerns about side effects were commonplace - for example, one-third (37%) of participants who had not taken up treatment worried "a lot" about 'side effects' - and that these concerns were underpinned by a general distrust and suspicion of medical institutions and their technologies, including widespread negative associations linked to interferon treatment. In trying to make sense of this, we draw on the concept of counterpublic health and its recognition that the everyday health needs, knowledges and aspirations of subordinated citizens frequently contradict the normative frameworks governing public health interventions. We suggest that failing to engage with concerns about 'side effects' could hinder elimination efforts. Our analysis suggests that addressing the issue of 'side effects' within the 'public' discourse of DAAs will not dampen or damage elimination efforts, as some might fear, but rather it will legitimate the concerns of people who inject, decrease their suspicion of medical interventions, and better support the uptake of DAA treatments. [ABSTRACT FROM AUTHOR]