Impact of current and scaled‐up levels of hepatitis C prevention and treatment interventions for people who inject drugs in three UK settings—what is required to achieve the WHO's HCV elimination targets?

Aims: We estimate the impact of existing high coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three United Kingdom (UK) settings. We determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organisation (WHO) target of reducing HCV incidence by 90% by 2030.

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.