Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe

Fraser, Hannah; Martin, Natasha K.; Brummer‐Korvenkontio, Henrikki; Carrieri, Patrizia; Dalgård, Olav; Dillon, John; Goldberg, David J.; Hutchinson, Sharon J.; Jauffret‐Roustide, Marie; Kåberg, Martin; Matser, Amy; Matičič, Mojca; Midgard, Håvard; Mravčík, Viktor; Øvrehus, Anne; Prins, Maria; Reimer, Jens; Robaeys, Geert; Schulte, Bernd; Santen, Daniëla K van; Zimmermann, Ruth; Vickerman, Peter; Hickman, Matthew

doi:10.1016/j.jhep.2017.10.010

Cited by 110 publications

(96 citation statements)

References 41 publications

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“…In Scotland, over 90% of new HCV infections occur among people who inject drugs (PWID) . HCV antibody prevalence among PWID is 58%, similar to other European countries …”

Section: Introductionsupporting

confidence: 70%

High response and re‐infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme

Schulkind

Stephens

Ahmad

et al. 2018

Journal of Viral Hepatitis

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Summary To achieve WHO hepatitis C virus (HCV) elimination targets by 2030, mathematical models suggest there needs to be significant scale‐up of treatment among people who inject drugs (PWID). We tested whether people who actively inject drugs can be recruited and treated successfully through a community needle and syringe programme (NSP), and assessed rates of re‐infection. 105 HCV RNA positive participants were enrolled prospectively. Participants were recruited from the largest NSP in Dundee over 42 months. 94/105 individuals commenced treatment. Genotype 1 (G1) individuals (n = 37) were treated with peg‐interferon+ribavirin+Simepravir/Telaprevir. Genotype 2/3 (G2/3) (n = 57) received peg‐interferon+ribavirin. Weekly study visits took place within the NSP. Mean age of participants was 34.0 years (SD 6.9), 71.3% (61/94) were male. One in five (20/94) participants were homeless. 68.1% (64/94) were on OST (opiate substitution therapy) at enrolment; participants injected median 6.5 times/wk. In terms of clinical outcomes, >80% treatment adherence was 71.3% (67/94). There was no difference in SVR‐12 rates by genotype: 81.0% (30/37) for G1 and 82.5% (47/55) for G2/3. At 18 months post‐treatment, 15/77 participants were reinfected, followed up over 69.8 person‐years, yielding a re‐infection rate of 21.5/100 person‐years (95% CI 13.00‐35.65). This trial demonstrates that HCV treatment can be delivered successfully to the target population of treatment as prevention strategies. We report higher rates of re‐infection than existing estimates among PWID. Scale‐up of HCV treatment should be pursued alongside a comprehensive programme of harm reduction interventions to help minimize re‐infection and reduce HCV transmission.

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“…In Scotland, over 90% of new HCV infections occur among people who inject drugs (PWID) . HCV antibody prevalence among PWID is 58%, similar to other European countries …”

Section: Introductionsupporting

confidence: 70%

High response and re‐infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme

Schulkind

Stephens

Ahmad

et al. 2018

Journal of Viral Hepatitis

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“…This mortality risk increases by another 1% annually in persons who continue to use intravenous drugs . Despite these data, modelling has suggested that treatment of HCV can reduce the prevalence of HCV in the reservoir of PWID and reduce the risk that a person new to or returning to injecting drugs after achieving SVR will come in contact with HCV and become infected or reinfected . A prospective study which demonstrates that such modelling is actually correct would be extremely useful for our elected officials who must provide funding to support these types of programmes.…”

Section: Treatment Of Hcv In Patients Who Inject Drugsmentioning

confidence: 99%

The next wave of hepatitis C virus: The epidemic of intravenous drug use

Shiffman

2018

Liver International

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The epidemic of hepatitis C virus (HCV) began in the 1960s when transmission was primarily the result of blood transfusions. By 1990, when HCV was identified and a serologic test for screening donated blood was implemented, 123 million persons had already become infected worldwide and HCV was the most common cause of cirrho- Highly effective oral antiviral agents are now available and can cure HCV in virtually all patients. Treatment can be highly effective in PWID with sustained virologic response rates similar to that observed in a non-drug-using population. Preventing the patient from returning to drug use and becoming reinfected with HCV is more difficult and will require that the medical and social problems associated with intravenous drug use be addressed and resolved.

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“…In western Europe, there are an estimated 1 009 500 (0.34% of the total population) PWID between 15 and 64 years of age . Treatment scale‐up has been identified as a requirement in order to achieve a reduction, or even the elimination, in HCV prevalence in most European countries …”

Section: Introductionmentioning

confidence: 99%

Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost‐effectiveness analysis

Girardin

Hearmon

Negro³

et al. 2018

Journal of Viral Hepatitis

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Summary People who inject drugs (PWID) are a key high‐risk group for Hepatitis C Virus (HCV) infection due to the sharing of needles and drug‐preparation equipment. However, only approximately 50% of PWID are currently screened for HCV in Switzerland. At present, screening of PWID occurs in general practice via venepuncture. Compared to venepuncture, screening via rapid antibody saliva and dried blood spot (DBS) tests is well adapted to PWID, who typically have difficult venous access. The cost‐effectiveness of an increased access screening programme of PWID (increased screening using rapid antibody saliva tests and DBS tests [semi‐quantitative viraemia and viral genotype]) was analysed through a decision tree screening model combined with the outputs of a Markov treatment model. Sensitivity and scenario analyses examined the uncertainty of results. At a willingness to pay (WTP) threshold of CHF 100 000 (USD 105 000) per quality‐adjusted life year (QALY), the increased access screening programme was cost‐effective compared to current screening, with a base case incremental cost‐effectiveness ratio of CHF 7 940 (USD 8337) per QALY. The net monetary benefit was CHF 959 802 668 (USD 1 007 792 801) for the PWID population and CHF 94 469 (USD 99 192) per person. The increased access screening programme had a 97.0% probability of being cost‐effective compared to the current screening method at the WTP threshold of CHF 100 000 (USD 105 000). The results showed an increased access screening programme that uses tests which are better suited to the PWID population to be more cost‐effective, due to the increased uptake that rapid antibody saliva and DBS tests generate.

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Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe

Abstract: 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).

Cited by 110 publications

References 41 publications

High response and re‐infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme

High response and re‐infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme

The next wave of hepatitis C virus: The epidemic of intravenous drug use

Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost‐effectiveness analysis

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