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.
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 language | English |
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Pages (from-to) | 402-411 |
Journal | Journal of Hepatology |
Volume | 68 |
Issue number | 3 |
Early online date | 25 Oct 2017 |
DOIs | |
Publication status | Published - 1 Mar 2018 |
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Professor Matt Hickman
- Bristol Medical School (PHS) - Professor in Public Health and Epidemiology - Deputy Head of School and Head of Population Health Sc
- Bristol Population Health Science Institute
- Health Protection Research Unit (HPRU)
- Centre for Academic Mental Health
- Infection and Immunity
- Centre for Academic Primary Care
Person: Academic , Member, Group lead
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Professor Peter T Vickerman
- Bristol Population Health Science Institute
- Health Protection Research Unit (HPRU)
- Bristol Medical School (PHS) - Professor of Infectious Disease Modelling
- Infection and Immunity
Person: Academic , Member