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

Abstract

Aims To project the impact of scaling up oral antiviral 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 programs to achieve specific targets and to examine whether hepatitis C viruse (HCV) elimination among PWID is possible in this high prevalence setting. Design A 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 reinfection following treatment. Setting/Participants The population of 8,300 PWID in Athens Metropolitan area Measurements Reduction in HCV prevalence and incidence in 2030 compared with 2016. Findings Moderate expansion of HCV treatment (treating 4%–8% of PWID/year), with simultaneous increase of 2%/year in harm reduction coverage (from 44% to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46%–90% in 2030, compared with 2016. CHC prevalence would reduce below 10% within the next 4–5 years 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. Conclusions Based on theoretical model projections, scaled-up hepatitis C virus (HCV) treatment and harm reduction interventions could achieve major reductions in HCV incidence and prevalence among people who inject drugs (PWID) in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4–5 years by increasing treatment to more than 16% of PWID per year combined with moderate increases in harm reduction coverage.

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

“…Subsequent studies have explored the potential of HCV treatment as prevention among PWID populations in a range of settings including North America, Europe, Asia and Australia . Broadly speaking, these studies have generally found that scale up of HCV treatment to rates to below 100 per 1000 PWID annually, particularly in combination with harm reduction , can reduce HCV incidence by 90% by 2030 across a wide range of settings. Results have been consistent between high and low income settings examined, such as Vietnam .…”

“…Several initial modelling studies in the UK and general PWID populations of varying prevalences have indicated that harm reduction alone is unlikely to achieve HCV elimination among PWID populations [13,14]. Subsequent studies have explored the potential of HCV treatment as prevention among PWID populations in a range of settings including North America, Europe, Asia and Australia [13,[15][16][17][18][19][20]. Broadly speaking, these studies have generally found that scale up of HCV treatment to rates to below 100 per 1000 PWID annually, particularly in combination with harm reduction [13,16,21], can reduce HCV incidence by 90% by 2030 across a wide range of settings.…”

“…In addition, a modelling study in the rural U.S. emphasized the importance of retreatment of reinfection in achieving elimination targets [21]. As such, elimination strategies likely require regular testing [22], HCV treatment [13,[15][16][17][18][19][20], harm reduction [13,16,21] and retreatment of reinfections [21].…”

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

“…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].…”

Dynamic modelling of hepatitis C transmission among people who inject drugs: A tool to support WHO elimination targets

“…partmental models has been studied before, e.g. Martin et al (2011Martin et al ( , 2013; Gountas et al (2017) and Fraser et al (2018). Often, HCV transmission models implicitly assume that everyone in the PWID population is currently injecting drugs (active) and that everyone who is infected is diagnosed.…”