Modelling the potential prevention benefits of a treat‐all hepatitis C treatment strategy at global, regional and country levels: A modelling study
Year: 2019
Type: article
Abstract: The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years. Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth rate and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth.
Source: Journal of Viral Hepatitis
DOI: 10.1111/jvh.13187
Institutions: National Institute for Health and Care Research, University of Bristol, UNSW Sydney, National Drug and Alcohol Research Centre, The University of Queensland, University of Washington, Institute for Health Metrics and Evaluation, Kirby Institute, University of California San Diego, University Hospitals Bristol NHS Foundation Trust, NIHR Bristol Biomedical Research Centre
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: World Health Organization, Gilead Sciences, Indivior, University Hospitals Bristol NHS Foundation Trust, Australian Government, National Institute for Health and Care Research, University of Bristol, University of New South Wales, Public Health England, Department of Health and Aged Care, Australian Government, Seqirus, National Institutes of Health, Center for AIDS Research, University of Washington, Medical Research Council, National Health and Medical Research Council, National Drug and Alcohol Research Centre, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases
Awards: Determining the impact of pharmaceutical opioid use in Australia: a focus on burden, risks and harms, G2864541731, Assessing the population health impact of illicit drug use: prevalence, trajectories, and contributions to disease burden, G4541530698, NIHR Senior Investigator Award, G8259150102, Increasing global and national knowledge about illicit drug use, harms and effective interventions, Increasing knowledge about substance use, mental health and harms, and interventions to prevent and reduce harm, 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, Modeling Structural HIV Determinants in Substance Users and related populations, G9000124410, San Diego Center for AIDS Research (SD CFAR)
OpenAlex ID: W2961525223