Modelling the potential prevention benefits of a treat‐all hepatitis C treatment strategy at global, regional and country levels: A modelling study

Abstract

The World Health Organization (WHO) recently produced guidelines advising a treatall policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years.Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis.

What is required for achieving hepatitis C virus elimination in Singapore? A modeling study

“…Our analysis supports modeling indicating that the WHO elimination targets are likely achievable among PWID if treatment is combined with harm reduction scale‐up 30 . Additionally, our analysis is consistent with studies indicating that fewer treatments are required if treatment is prioritized to PWID and/or PWID and those with cirrhosis or more advanced disease, as well as if harm reduction is provided in combination 22,31 .…”

Socio-demographic and ecological factors associated with anti-HCV prevalence in people who inject drugs: A systematic review

“…This offers an opportunity to intervene, and potentially control transmission rates, before the burden becomes as prevalent among PWID as it has in developed countries. Targeting PWID in regions such as Sub-Saharan Africa and Asia has been shown to result in a much higher rate of averted infections compared to their more economically developed counterparts (Trickey et al, 2019b).…”

Hepatitis C elimination – Macro‐elimination

“…Multiple and expanded micro‐elimination efforts in different high‐risk groups could result in macro‐elimination on a country/regional basis. A study modelling the potential prevention benefit of a hepatitis C treatment‐for‐all strategy on global, regional and country levels was recently published . This study concluded that significant prevention benefits were obtained from the WHO treat‐all strategy, although there was more benefit per treatment when PWID were targeted …”