Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe

Hannah Fraser, Natasha Martin, Henrikki Brummer-Korvenkontio, Patrizia Carrieri, Olav Dalgard, John Dillon, David Goldberg, Sharon Hutchinson, Marie Jauffret-Roustide, Martin Kaberg, Amy Matser, Mojca Matičič, Håvard Midgard, Viktor Mravčík, Anne Øvrehus, Maria Prins, Jens Reimer, Geert Robaeys, Bernd Schulte, Daniela van SantenRuth Zimmermann, Peter Vickerman, Matthew Hickman

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes (NSP) across Europe over the next 10 years.

Methods: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence among PWID.

Results: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. Current treatment rates using new direct acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia and Amsterdam. Doubling HCV-treatment rates will reduce prevalence in other sites (12-24%, Belgium/Denmark/Hamburg/Norway/Scotland) but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate to substantial increases in current treatment rates are required to achieve the same impact elsewhere, from 1.4-3 times (Czech Republic/France), 5-17 times (France/Scotland/Hamburg/Norway/Denmark/Belgium/Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%.

Conclusions: Scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.
Original languageEnglish
Pages (from-to)402-411
JournalJournal of Hepatology
Volume68
Issue number3
Early online date25 Oct 2017
DOIs
Publication statusPublished - 1 Mar 2018

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