Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Stone, Jack; Martin, Natasha K.; Hickman, Matthew; Hutchinson, Sharon J.; Aspinall, Esther; Taylor, Avril; Munro, Alison; Dunleavy, Karen; Peters, Erica J.; Bramley, Peter; Hayes, Peter; Goldberg, David J.; Vickerman, Peter

doi:10.1111/add.13783

Cited by 83 publications

(111 citation statements)

References 41 publications

(62 reference statements)

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“…These findings, while unique in terms of assessing drug law reform impact, support previous modelling studies indicating that reductions in incarceration could reduce HIV and hepatitis C transmission in people who inject drugs. 2,8,9 The narcomenudeo reform in Mexico carries the potential to address structural factors in people who inject drugs that increase their HIV risk. Unfortunately, stark discrepancies between written laws and policing practices in Tijuana have translated into minimal benefits, and potential harms.…”

Section: Discussionmentioning

confidence: 99%

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The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study

Bórquez

Beletsky

Nosyk

et al. 2018

The Lancet Public Health

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Summary Background As countries embark on public health-oriented drug law reform, health impact evaluations are needed. In 2012, Mexico mandated the narcomenudeo reform, which depenalised the possession of small amounts of drugs and instituted drug treatment instead of incarceration. We investigated the past and future effect of this drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico. Methods In this epidemic modelling study, we used data from the El Cuete IV cohort study to develop a deterministic model of injecting and sexual HIV transmission in people who inject drugs in Tijuana between 2012 and 2030. The population was stratified by sex, incarceration status, syringe confiscation by the police, HIV stage, and exposure to drug treatment or rehabilitation (either opioid agonist treatment or compulsory drug abstinence programmes). We modelled the effect of these exposures on HIV risk in people who inject drugs, estimating the effect of observed and potential future reform enforcement levels. Findings In 2011, prior to the narcomenudeo reform, 547 (75%) of 733 people who inject drugs in the El Cuete cohort reported having ever been incarcerated, on average five times since starting injecting. Modelling estimated the limited reform implementation averted 2% (95% CI 0·2–3·0) of new HIV infections in people who inject drugs between 2012 and 2017. If implementation reduced incarceration in people who inject drugs by 80% from 2018 onward, 9% (95% CI 4–16) of new HIV infections between 2018 and 2030 could be averted, with 21% (10–33) averted if people who inject drugs were referred to opioid agonist treatment instead of being incarcerated. Referral to compulsory drug abstinence programmes instead of prison could have a lower or potentially negative impact with −2% (95% CI −23 to 9) infections averted. Interpretation Mexican drug law reform has had a negligible effect on the HIV epidemic among people who inject drugs in Tijuana. However, appropriate implementation could markedly reduce HIV incidence if linked to opioid agonist treatment. Unfortunately, compulsory drug abstinence programmes are the main type of drug rehabilitation available and their expansion could potentially increase HIV transmission.

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Section: Discussionmentioning

confidence: 99%

“…7 Three modelling studies have assessed the contribution of incarceration to HIV, hepatitis C, and tuberculosis epidemics in people who inject drugs, but none have evaluated the effect of drug law reform on disease incidence. 2,8,9 …”

Section: Introductionmentioning

confidence: 99%

The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study

Bórquez

Beletsky

Nosyk

et al. 2018

The Lancet Public Health

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“…However, this collective benefit is only based on indirect evidence from dynamic mathematical models suggesting that HCV treatment of PWID is likely to lead to reductions in HCV incidence and transmission . No real‐life direct observational data have been available . For other populations at risk of HCV transmission, beside universal HCV treatment and scaling up of diagnosis, an increase in preventive measures such as safe medical procedures, safe sexual practices and prevention of mother‐to‐child transmission needs to be encouraged…”

Section: Collective Benefits Of Hcv Therapymentioning

confidence: 99%

“…78 No real-life direct observational data have been available. 79 For other populations at risk of HCV transmission, beside universal HCV treatment and scaling up of diagnosis, an increase in preventive measures such as safe medical procedures, safe sexual practices and prevention of mother-to-child transmission needs to be encouraged. 60 In the era of highly effective DAAs that promise both an individual and a collective benefit, the World Health Organization (WHO) has launched the first global health strategy on the elimination of viral hepatitis as a public health threat by 2030.…”

Section: Collective Benefits Of Hcv Therapymentioning

confidence: 99%

The benefits of hepatitis C virus cure: Every rose has thorns

Salmon

Mondelli

Matičič

et al. 2018

Journal of Viral Hepatitis

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To examine mid-term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct-acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.

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“…In most countries these targets can be achieved only through scaling-up both OST, NSP and HCV treatment for PWID, as highlighted in a recent paper (the first in our series) on HCV in Greece [19]. Another model study in our series shows that managing HCV in prisons can make a substantial contribution to reducing transmission in the community [20]. Several countries, such as Australia, France, Georgia and Portugal, have already announced and started national HCV elimination campaigns, increasing the number of HCV treatments available and removing any restrictions on access [21,22].…”

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confidence: 73%

New developments and opportunities for preventing hepatitis C virus (HCV) among people who use and inject drugs-announcing anAddictionseries

et al. 2017

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We announce a new series for Addiction on HCV (hepatitis C virus). This is prompted by the changing treatment and prevention landscape and syndemic of HCV and drug use, specifically concerning people who inject drugs (PWID). In some developing countries more than 80% of HCV is among people with a history of drug injection; globally, almost 40% of HCV burden is attributable to injecting drug use and in many countries one in two PWID are likely to be living with HCV [1][2][3]. HCV is an important cause of liver disease, along with alcohol, hepatitis B virus (HBV) and metabolic causes, and the only one that can be cured easily [4]. There is no vaccine available for HCV. However, new HCV anti-viral drugs-so-called direct-acting anti-virals (DAAs)-are highly tolerable, of short duration (8-12 weeks) and can cure the disease in the vast majority of cases, with trials involving PWID reporting more than 90% cure rates [5][6][7].These advancements have raised excitement around the possibility of using HCV treatment as Prevention (TasP). Globally, however, very few PWID are treated for their HCV. Although the cost of DAA therapies can be high, health economic models suggest that prioritizing PWID for early HCV treatment because of the prevention benefits is likely to be cost-effective [8]. In addition, there is strengthening empirical evidence that primary prevention interventions such as opioid substitution treatment (OST) and needle and syringe programmes (NSP) can reduce HIV and HCV [9][10][11][12]. However, theoretical model projections suggest that substantial reductions in HCV transmission among PWID will require both traditional harm reduction/primary prevention and HCV treatment scale-up [13,14]. The ease of administration of these new DAA therapies means that they could be delivered by non-specialists in the community and within drug treatment services, leading to the recommendation that HCV treatment, drug treatment and prevention services should be integrated, which may have advantages and disadvantages in the way that drug treatment services are delivered [15].International clinical guidelines recommend that people at risk of transmitting HCV are treated for HCV [16][17][18]. The World Health Organization Global Health Sector Strategy (GHSS) on Viral Hepatitis has set a challenging goal of eliminating viral hepatitis as a major public health threat by 2030, reducing new chronic infections by 90% and mortality by 65%. In most countries these targets can be achieved only through scaling-up both OST, NSP and HCV treatment for PWID, as highlighted in a recent paper (the first in our series) on HCV in Greece [19]. Another model study in our series shows that managing HCV in prisons can make a substantial contribution to reducing transmission in the community [20]. Several countries, such as Australia, France, Georgia and Portugal, have already announced and started national HCV elimination campaigns, increasing the number of HCV treatments available and removing any restrictions on access [21,22]. There are great o...

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Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Cited by 83 publications

References 41 publications

The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study

The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study

The benefits of hepatitis C virus cure: Every rose has thorns

New developments and opportunities for preventing hepatitis C virus (HCV) among people who use and inject drugs-announcing anAddictionseries

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