Scaling Up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States: A Rural and Urban Comparison
Year: 2019
Type: article
Abstract: In the United States, hepatitis C virus (HCV) transmission is rising among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modeling, we investigated the impact of scaling up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky, and San Francisco, California, where HCV seroprevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban San Francisco (established community) than in rural Perry County (young, expanding community). We modeled the proportion of HCV-infected PWID needing HCV treatment annually to reduce HCV incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (Perry County only) from 2017. With current MAT and SSP coverage during 2017-2030, HCV incidence would increase in Perry County (from 21.3 to 22.6 per 100 person-years) and decrease in San Francisco (from 12.9 to 11.9 per 100 person-years). With concurrent MAT and SSP scale-up, 5% per year of HCV-infected PWID would need HCV treatment in Perry County to achieve incidence targets-13% per year without MAT and SSP scale-up. In San Francisco, a similar proportion would need HCV treatment (10% per year) irrespective of MAT scale-up. Reaching the same impact by 2025 would require increases in treatment rates of 45%-82%. Achievable provision of HCV treatment, alongside MAT and SSP scale-up (Perry County) and MAT scale-up (San Francisco), could reduce HCV incidence.
Source: American Journal of Epidemiology
DOI: 10.1093/aje/kwz097
Authors: Hannah Fraser, Claudia Vellozzi, Thomas J Hoerger, Jennifer L Evans, Alex H Kral, Jennifer Havens, April M Young, Jack Stone, Senad Handanagic, Susan Hariri, Carolina Barbosa, Matthew Hickman, Alyssa Leib, Natasha K Martin, Lina Nerlander, Henry F Raymond, Kimberly Page, Jon Zibbell, John W Ward, Peter Vickerman
Institutions: University of Bristol, Grady Health System, RTI International, University of California, San Francisco, University of Kentucky, Centers for Disease Control and Prevention, University of Colorado Denver, University of California San Diego, San Francisco Department of Public Health, University of New Mexico, University of New Mexico Health Sciences Center, The Task Force for Global Health
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Gilead Sciences, RTI International, National Institute for Health Research Health Protection Research Unit, National Institute for Health and Care Research, University of Bristol, National Institutes of Health, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, University of California, San Diego, Engineering and Physical Sciences Research Council, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases
Awards: G1590704979, G2587916271, G3789320706, G380885746, Social networks and HIV risk among rural drug users, G495691247, G5232765764, NIHR Senior Investigator Award, G7664844333, G8259150102, Evaluating the Population Impact of Hepatitis C Direct Acting Antivral Treatment as Prevention for People Who Inject Drugs (EPIToPe), Can HCV treatment be delivered to injecting drug users in order to reduce HCV transmission and prevalence in the population: an empirical demonstration and evaluation, G9000016604, G9000124410, San Diego Center for AIDS Research (SD CFAR)
OpenAlex ID: W2947994209