Design HCV transmission modelling utilising UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition
Setting Three UK cities with varying HCV antibody prevalence (Bristol 60%, Dundee 46%, Walsall 32%), OST (72-81%), and HCNSP coverage (28-56%).
Measurements Relative change in new HCV infections over 2016-2030 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.
Findings Removing HCNSP or OST would increase the number of new HCV infections over 2016-2030 by 23-64% and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29% or 49% reduction in Bristol and Walsall, respectively, whereas Dundee achieves a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently 1-3 and 6-12 treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.
Conclusions Current opioid substitution therapy and high coverage needle and syringe provision coverage is averting substantial Hepatitis C transmission in the United Kingdom. Maintaining this coverage while initiating current injectors on treatment can reduce incidence by 90% by 2030.
- HCV treatment scale-up
- hepatitis C virus
- mathematical model
- needle and syringe provision
- opioid substitution therapy
- people who inject drugs