Effectiveness of needle/syringe programmes and opiate substitution therapy in preventing HCV transmission among people who inject drugs

Platt, Lucy; Reed, Jennifer; Vickerman, Peter; Hagan, Holly; French, Clare E; Jordan, Ashly E.; Degenhardt, Louisa; Hope, Vivian; Hutchinson, Sharon; Maher, Lisa; Palmateer, Norah; Taylor, Avril; Hickman, Matthew

doi:10.1002/14651858.cd012021

Cited by 41 publications

(39 citation statements)

References 22 publications

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“…As modelling studies have shown that more frequent testing for HCV and earlier initiation of HCV treatment could reduce the HCV epidemic among HIV‐positive MSM and given that those previously infected with HCV are a particularly high risk sub‐population for transmission, reducing the time from reinfection to retreatment is important. This could be achieved by increasing the frequency of HCV reinfection screening and may require out of the box diagnostic strategies like a home‐based diagnostic approach in which the patient collects dried blot spots that are sent to the lab for HCV RNA or antigen testing. Harm reduction and other behavioural interventions to prevent infection/reinfection: Despite the importance of harm reduction such as OST and needle and syringe programs for preventing HCV infection among PWID , access to these interventions in many settings is poor, particularly in many resource limited settings . Scale‐up of harm reduction, as recommended by the WHO , is crucial.…”

Section: Resultsmentioning

confidence: 99%

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

et al. 2018

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IntroductionThe World Health Organization targets for hepatitis C virus (HCV) elimination include a 90% reduction in new infections by 2030. Our objective is to review the modelling evidence and cost data surrounding feasibility of HCV elimination among people living with HIV (PLWH), and identify likely components for elimination. We also discuss the real‐world experience of HCV direct acting antiviral (DAA) scale‐up and elimination efforts in the Netherlands.MethodsWe review modelling evidence of what intervention scale‐up is required to achieve WHO HCV elimination targets among HIV‐infected (HIV+) people who inject drugs (PWID) and men who have sex with men (MSM), review cost‐effectiveness of HCV therapy among PLWH and discuss economic implications of elimination. We additionally use the real‐world experience of DAA scale‐up in the Netherlands to illustrate the promise and potential challenges of HCV elimination strategies in MSM. Finally, we summarize key components of the HCV elimination response among PWLH.Results and discussionModelling indicates HCV elimination among HIV+ MSM and PWID is potentially achievable but requires combination treatment and either harm reduction or behavioural risk reductions. Preliminary modelling indicates elimination among HIV+ PWID will require elimination efforts among PWID more broadly. Treatment for PLWH and high‐risk populations (PWID and MSM) is cost‐effective in high‐income countries, but costs of DAAs remain a barrier to scale‐up worldwide despite the potential low production price ($50 per 12 week course). In the Netherlands, universal DAA availability led to rapid uptake among HIV+ MSM in 2015/16, and a 50% reduction in acute HCV incidence among HIV+ MSM from 2014 to 2016 was observed. In addition to HCV treatment, elimination among PLWH globally also likely requires regular HCV testing, development of low‐cost accurate HCV diagnostics, reduced costs of DAA therapy, broad treatment access without restrictions, close monitoring for HCV reinfection and retreatment, and harm reduction and/or behavioural interventions.ConclusionsAchieving WHO HCV Elimination targets is potentially achievable among HIV‐infected populations. Among HIV+ PWID, it likely requires HCV treatment scale‐up combined with harm reduction for both HIV+ and HIV‐ populations. Among HIV+ MSM, elimination likely requires both HCV treatment and behaviour risk reduction among the HIV+ MSM population, the latter of which to date has not been observed. Lower HCV diagnostic and treatment costs will be key to ensuring scale‐up of HCV testing and treatment without restriction, enabling elimination.

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Section: Resultsmentioning

confidence: 99%

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

et al. 2018

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“…Dr. Hickman presented results from a recent Cochrane Review of 15 studies including 1089 HCV cases over 4262 person years of follow-up time. Pooled results demonstrated that exposure to OST resulted in at least a 54% risk reduction in HCV transmission [47]. Although OST and NSP have been shown to prevent HCV infections, the coverage required to achieve substantial HCV prevalence reductions may be unsustainable (80% compared to the current 50%) and therefore unlikely to be achieved [48].…”

Section: The 5th Canadian Symposium On Hcv (Cshcv)mentioning

confidence: 99%

The 5th Canadian Symposium on Hepatitis C Virus: We Are Not Done Yet—Remaining Challenges in Hepatitis C

Buuren

Fradette

Grebely

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Hepatitis C virus (HCV) affects approximately 268,000 Canadians and results in more years of life lost than any other infectious disease in the country. Both the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC) have identified HCV-related liver disease as a priority and supported the establishment of a National Hepatitis C Research Network. In 2015, the introduction of new interferon- (IFN-) free therapies with high cure rates (>90%) and few side effects revolutionized HCV therapy. However, a considerable proportion of the population remains undiagnosed and treatment uptake remains low in Canada due to financial, geographical, cultural, and social barriers. Comprehensive prevention strategies, including enhanced harm reduction, broader screening, widespread treatment, and vaccine development, are far from being realized. The theme of the 2016 symposium, “We're not done yet: remaining challenges in Hepatitis C,” was focused on identifying strategies to enhance prevention, diagnosis, and treatment of HCV to reduce disease burden and ultimately eliminate HCV in Canada.

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“…Although historically viewed as being difficult to treat, PWID have been recently shown to have treatment adherence and SVR rates comparable to non-drug users (Elsherif et al, 2017) as well as a low re-infection rate (1.14 per 100 person-years)(Islam et al, 2017), indicating equally effective applicability of DAA therapy to this high-risk population. Several public health interventions (PHI) are currently available for effectively controlling HCV infections among PWID if coverage is sufficient; namely, specific DAA therapy and harm reduction programs, including syringe service programs, medication substitution treatment and peer-education interventions (PEI) (Bruggmann and Grebely, 2015; Platt et al, 2016). Although each of the interventions can contribute to reduction of incidence and prevalence of HCV infection among PWID, significant cost, complex logistics and social factors confound application of the interventions, indicating need for the development of efficient implementation strategies to eliminate hepatitis C in these communities.…”

Section: Introductionmentioning

confidence: 99%

Intelligent Network DisRuption Analysis (INDRA): A targeted strategy for efficient interruption of hepatitis C transmissions

Campo

Khudyakov

2018

Infection, Genetics and Evolution

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Hepatitis C virus (HCV) infection is a global public health problem. The implementation of public health interventions (PHI) to control HCV infection could effectively interrupt HCV transmission. PHI targeting high-risk populations, e.g., people who inject drugs (PWID), are the most efficient but there is a lack of tools for prioritizing individuals within a high-risk community. Here, we present Intelligent Network DisRuption Analysis (INDRA), a targeted strategy for efficient interruption of hepatitis C transmissions. Using a large HCV transmission network among PWID in Indiana as an example, we compare effectiveness of random and targeted strategies in reducing the rate of HCV transmission in two settings: (1) long-established and (2) rapidly spreading infections (outbreak). Identification of high centrality for the network nodes co-infected with HIV or >1 HCV subtype indicates that the network structure properly represents the underlying contacts among PWID relevant to the transmission of these infections. Changes in the network’s global efficiency (GE) were used as a measure of the PHI effects. In setting 1, simulation experiments showed that a 50% GE reduction can be achieved by removing 11.2 times less nodes using targeted vs random strategies. A greater effect of targeted strategies on GE was consistently observed when networks were simulated: (1) with a varying degree of errors in node sampling and link assignment, and (2) at different levels of transmission reduction at affected nodes. In simulations considering a 10% removal of infected nodes, targeted strategies were ~2.8 times more effective than random in reducing incidence. Peer-education intervention (PEI) was modeled as a probabilistic distribution of actionable knowledge of safe injection practices from the affected node to adjacent nodes in the network. Addition of PEI to the models resulted in a 2–3 times greater reduction in incidence than from direct PHI alone. In setting 2, however, random direct PHI were ~3.2 times more effective in reducing incidence at the simulated conditions. Nevertheless, addition of PEI resulted in a ~1.7-fold greater efficiency of targeted PHI. In conclusion, targeted PHI facilitated by INDRA outperforms random strategies in decreasing circulation of long-established infections. Network-based PEI may amplify effects of PHI on incidence reduction in both settings.

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Effectiveness of needle/syringe programmes and opiate substitution therapy in preventing HCV transmission among people who inject drugs

Cited by 41 publications

References 22 publications

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

The 5th Canadian Symposium on Hepatitis C Virus: We Are Not Done Yet—Remaining Challenges in Hepatitis C

Intelligent Network DisRuption Analysis (INDRA): A targeted strategy for efficient interruption of hepatitis C transmissions

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