Comment www.thelancet.com/infection Vol 12 March 2012 173 and monitoring plan with clear and measurable targets. The success of the strategy in meeting objectives such as increasing access to sterile injecting equipment through NSPs will be measured by indicators including the per-capita rate of needles and syringes distributed in the previous 12 months and the proportion of IDUs who report re-using another person’s used needle and syringe in the past month. Another objective is to reduce the burden of disease attributed to chronic hepatitis C, which will be measured by estimation of the number of people living with hepatitis C infection by stage of liver disease, as well as self-reported health status. Crucially, the strategy also aims to increase access to clinical care, which will be assessed by monitoring the proportion of people with chronic hepatitis C who received dispensed drugs for their infection in the past 12 months. Strategies, whether national or global, need to be accompanied by clear targets and dedicated resources, not only to promote action in terms of prevention of new infections, improve access to treatment and care, and reduce stigma and discrimination, but also to assess the effectiveness of the strategies in meeting their declared objectives. The need for quality assessment is even more important with the HCV direct-acting antivirals that are in development and that have improved toxicity profiles and simplified dosing regimens and the prospect of interferon-free therapy, 11 which raises the possibility—in some settings at least—of HCV treatment as prevention. In this regard, Australia’s latest hepatitis C strategy and the accompanying National Surveillance and Monitoring Plan 12 are steps in the right direction. Hopefully other countries will be paying attention. Lisa Maher Kirby Institute, Centre for Immunology, Darlinghurst, Sydney, NSW, Australia lmaher@kirby.unsw.edu.au LM chaired the recent Hepatitis C Working Group sub-committee of the Communicable Disease Network of Australia and receives funding from the Department of Health and Ageing for the conduct of the Australian Needle and Syringe Program Survey. 1 Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 2005; 5: 558–67. 2 Volk ML, Tocco R, Saini S, et al. Public health impact of antiviral therapy for hepatitis C in the United States. Hepatology 2009; 50: 1750–55. 3 Lettmeier B, Muhlberger N, Schwarzer R, et al. Market uptake of new antiviral drugs for the treatment of hepatitis C. J Hepatol 2008; 49: 528–36. 4 Joshi D, O’Grady J, Dieterich D, et al. Increasing burden of liver disease in patients with HIV infection. Lancet 2011; 377: 1198–209. 5 WHO. Viral hepatitis. March 25, 2010. http://apps.who.int/gb/ebwha/pdf_ files/WHA63/A63_15-en.pdf (accessed Nov 26, 2011). 6 Morris K. Tackling hepatitis C: a tale of two countries. Lancet 2011; 377: 1227–28. 7 National Centre in HIV Epidemiology and Clinical Research. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2010. http://www.med.unsw.edu.au/NCHECRweb.nsf/ resources/SurvRep07/$file/ASR2010-rev1.pdf (accessed April 21, 2011). 8 Maher L, Jalaludin B, Chant KG, et al. Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Addiction 2006; 101: 1499–508. 9 National Centre in HIV Epidemiology and Clinical Research. Australia NSP Survey National Data Report 2005–2009. Prevalence of HIV, HCV and injecting and sexual behaviour among IDUs at needle and syringe programs. http://www.med.unsw.edu.au/NCHECRweb.nsf/resources/NSP_ Complete2/$file/ANSP.NDR.2005_2009.pdf (accessed April 21, 2011). 10 Australian Government Department of Health and Ageing. Third National Hepatitis C Strategy 2010–2103. http://www.health.gov.au/internet/main/ publishing.nsf/Content/ohp-national-strategies-2010-hcv/$File/hcv.pdf (accessed Dec 5, 2011). 11 Gane EJ, Stedman CA, Hyland RH. Once Daily PSI-7977 plus RBV: pegylated interferon-alfa not required for complete rapid viral response in treatment-naive patients with HCV GT2 or GT3. 62nd Annual Meeting of the American Association for the Study of Liver Disease (AASLD 2011); San Francisco; Nov 4–8, 2011. Abstract 34. 12 Communicable Diseases Network of Australia. National Blood-borne Virus and Sexually Transmissible Infections Surveillance and Monitoring Plan. http://www.health.gov.au/internet/main/publishing.nsf/Content/095DD5 019EA33DBECA2579600079042D/$File/monitoring-plan.pdf (accessed Jan 16, 2012). Supply chain problems for Chagas disease treatment The production of benznidazole, the first-line treatment for Chagas disease, is now resuming, thereby remedying a global shortage of this medicine. 1 This news is especially welcome because treatment efforts for this neglected parasitic disease had only recently begun to scale-up. Millions of people are infected with Trypanosoma cruzi, the aetiological agent of Chagas disease, but supply chain problems persist for the two medicines available to treat this disease, benznidazole and nifurtimox. These problems include potential interactions between the supply chains for the two products, limited public-treatment data, and inadequate treatment-monitoring systems. Two events in the past decade substantially altered the supply chains of benznidazole and nifurtimox. In 2002, Bayer began donating nifurtimox to WHO. 2,3 The WHO–Bayer donation programme substantially expanded access to nifurtimox around the world. In 2003, the technology and production of benznidazole were transferred from Roche to Lafepe, a government pharmaceutical company in Pernambuco state, Brazil. Since that time, however, Lafepe’s production of