Treatment as prevention among injecting drug users; extrapolating from the Amsterdam cohort study

Vos, Anneke S. de; Prins, Maria; Coutinho, Roel A.; Helm, Jürgen; Kretzschmar, Mirjam

doi:10.1097/qad.0000000000000190

Cited by 6 publications

(3 citation statements)

References 28 publications

(35 reference statements)

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“…An individual-based model describing demographic changes and infection dynamics of HIV and HCV was employed. This model was used previously to study the effects of harm reduction policy on the spread of HIV and HCV in Amsterdam [ 18 ], as well as the potential of treatment as prevention for HIV among PWID [ 19 ]. Since detailed features have been described before [ 18 ],below we describe only the main features of this model and how it was adapted.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands

et al. 2016

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BackgroundPeople who inject drugs (PWID) are disproportionally affected by the hepatitis C virus (HCV) infection. The efficacy of HCV treatment has significantly improved in recent years with the introduction of direct-acting antivirals (DAAs). However, DAAs are more costly than pegylated-interferon and ribavirin (PegIFN/RBV). We aimed to assess the cost-effectiveness of four HCV treatment strategies among PWID and treatment scale-up.MethodsAn individual-based model was used describing HIV and HCV transmission and disease progression among PWID. We considered two epidemiological situations. A declining epidemic, based on the situation in Amsterdam, the Netherlands, and a stable HCV epidemic, as observed in other settings. Data on HCV incidence, prevalence, treatment setting and uptake were derived from observed data among PWID in Amsterdam. We assessed the incremental cost-effectiveness ratio (ICER, costs in €/quality-adjusted life year (QALY)) of four treatment strategies: 1) PegIFN/RBV; 2) sofosbuvir/RBV for genotype 2–3 and dual DAA for genotype 1–4; 3) Dual DAA for all genotypes; 4) Dual DAA with 3x treatment uptake.ResultsIn both types of epidemic, dual DAA therapy was most cost-effective strategy. In the declining epidemic, dual DAA yielded an ICER of 344 €/QALY while in the stable epidemic dual DAA led to cost-savings. Scaling-up treatment was also highly cost-effective. Our results were robust over a range of sensitivity analyses.ConclusionHCV treatment with DAA-containing regimens is a highly cost-effective intervention among PWID. Based on the economic and population benefits of scaling-up treatment, stronger efforts are needed to achieve higher uptake rates among PWID.

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Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands

et al. 2016

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“…Mathematical and statistical modelling has more generally been useful to improve our understanding of intervention effectiveness and cost-effectiveness as well as to give insight in potential epidemic courses and processes, thus providing some basis to evaluate interventions [95–97, 130–134]. Different types of intervention have been studied using mathematical models, such as impact of needle exchange programmes [135, 136], impact of behavioural changes [137] and impact of treatment on transmission [138, 139]. Recent studies suggest that molecular analyses of infectious diseases may also provide added value to epidemiological surveillance as a basis for evaluating interventions [48, 140–143].…”

Section: Discussionmentioning

confidence: 99%

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

et al. 2017

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Background and aimsDespite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality.Methods and resultsThe framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included ‘coverage’, ‘waiting list time’, ‘dosage’ and ‘availability in prisons’. For the specific NSP indicators, the priority indicators included ‘coverage’, ‘number of needles/syringes distributed/collected’, ‘provision of other drug use paraphernalia’ and ‘availability in prisons’. Among the generic or cross-cutting indicators the priority indicators were ‘infectious diseases counselling and care’, ‘take away naloxone’, ‘information on safe use/sex’ and ‘condoms’. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries.ConclusionsThe establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

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“…Several studies have examined the relationship between community HIV viral load and HIV seroconversion, including in Vancouver, Canada [3], San Francisco, California [4], and British Columbia, Canada [5, 6]. Each study found that reductions in community HIV viral load corresponded to reductions in HIV incidence in the communities and there has since been a global push to adopt HIV treatment as prevention [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Measures of human immunodeficiency virus (HIV) community viral load and HIV incidence among people who inject drugs

Glasheen

Johnson

Lorvick

et al. 2018

Annals of Epidemiology

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Treatment as prevention among injecting drug users; extrapolating from the Amsterdam cohort study

Abstract: A test and immediate treat strategy for HIV among IDU could lead to great reductions in incidence. To fully eliminate the spread of HIV, treatment as prevention should be combined with other interventions, with behavioral intervention directed at those not yet HIV infected.

Cited by 6 publications

References 28 publications

Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands

Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

Measures of human immunodeficiency virus (HIV) community viral load and HIV incidence among people who inject drugs

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