Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe
Year: 2018
Type: article
Abstract: BACKGROUND & AIMS: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. METHODS: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. RESULTS: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. CONCLUSIONS: The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. LAY SUMMARY: Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).
Source: Journal of Hepatology
Authors: Hannah Fraser, Natasha K. Martin, Henrikki Brummer-Korvenkontio, Patrizia Carrieri, Olav Dalgard, John Dillon, David Goldberg, Sharon Hutchinson, Marie Jauffret-Roustide, Martin Kåberg, Amy A. Matser, Mojca Matičič, Havard Midgard, Viktor Mravcik, Anne Øvrehus, Maria Prins, Jens Reimer, Geert Robaeys, Bernd Schulte, Daniela K. van Santen, Ruth Zimmermann, Peter Vickerman, Matthew Hickman
Institutions: University of Bristol, University of California San Diego, Finnish Institute for Health and Welfare, Inserm, Aix-Marseille Université, Economic & Social Sciences, Health Systems & Medical Informatics, Institut de Recherche pour le Développement, University of Oslo, Akershus University Hospital, University of Dundee, Health Protection Scotland, Glasgow Caledonian University, Centre National de la Recherche Scientifique, Institut de Veille Sanitaire, Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société, Université Paris Descartes, École des hautes études en sciences sociales, Karolinska University Hospital, Karolinska Institutet, University Medical Center Utrecht, GGD Amsterdam, University of Ljubljana, Ljubljana University Medical Centre, Charles University, General University Hospital in Prague, National Institute of Mental Health, Odense University Hospital, Amsterdam UMC Location University of Amsterdam, University of Amsterdam, Universität Hamburg, Universitair Ziekenhuis Leuven, Ziekenhuis Oost-Limburg, Hasselt University, Robert Koch Institute
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,500
Funders: National Institute for Health Research Health Protection Research Unit, National Institute for Health and Care Research, European Commission, University of Bristol, Ministerstvo Školství, Mládeže a Tělovýchovy, Public Health England, National Institutes of Health, Center for AIDS Research, University of Washington, University of California, San Diego, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases
Awards: G3789320706, G495691247, G5202045387, NIHR Senior Investigator Award, G7381802901, Sustainability for The National Institute of Mental Health, G8259150102, 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: W2765561710