Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting?

Authored by Ilias Gountas, Vana Sypsa, Olga Anagnostou, Natasha Martin, Peter Vickerman, Evangelos Kafetzopoulos, Angelos Hatzakis

Date Published: 2017

DOI: 10.1111/add.13764

Sponsors: No sponsors listed

Platforms: C++

Model Documentation: Other Narrative

Model Code URLs: Model code not found

Abstract

AimsTo project the impact of scaling-up oral anti-viral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programmes to achieve specific targets and to examine whether hepatitis C virus (HCV) elimination among PWID is possible in this high-prevalence setting. DesignA dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for re-infection following treatment. Setting/participantsThe population of 8300 PWID in Athens Metropolitan area. MeasurementsReduction in HCV prevalence and incidence in 2030 compared with 2016. FindingsModerate expansion of HCV treatment (treating 4-8\% of PWID/year), with a simultaneous increase of 2\%/year in harm reduction coverage (from 44 to 72\% coverage over 15years), was projected to reduce CHC prevalence among PWID in Athens by 46.2-94.8\% in 2030, compared with 2016. CHC prevalence would reduce to below 10\% within the next 4-5years if annual HCV treatment numbers were increased up to 16-20\% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates. ConclusionsBased on theoretical model projections, scaled-up hepatitis C virus treatment and harm reduction interventions could achieve major reductions in hepatitis C virus incidence and prevalence among people who inject drugs in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4-5years by increasing treatment to more than 16\% of people who inject drugs per year combined with moderate increases in harm reduction coverage.

Tags

Elimination dynamic modeling transmission Virus-infection Users Follow-up Opiate substitution therapy Antiviral treatment Syringe programs Reinfection Antiviral therapy Greece Harm reduction Hepatitis c Treatment as prevention Hcv infection