Prison-based interventions are key to achieving HCV elimination among people who inject drugs in New South Wales, Australia: a modelling study

Jack Stone*, Aaron G Lim, Gregory J. Dore, Annick Borquez, Louise Geddes, Richard Gray, Jason Grebely, Bezhad Hajarizadeh, Jenny Iversen, Lisa Maher, Heather Valerio, Natasha Martin, Matt Hickman, Andrew Lloyd, Peter T Vickerman

*Corresponding author for this work

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

6 Citations (Scopus)
32 Downloads (Pure)

Abstract

Background & Aims
People who inject drugs (PWID) experience high incarceration rates which are associated with increased hepatitis C virus (HCV) transmission risk. We assess the importance of prison-based interventions for achieving HCV elimination among PWID in New South Wales (NSW), Australia.

Methods
A model of incarceration and HCV transmission among PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from NSW, incorporating elevated HCV acquisition risk among recently released PWID. We projected the contribution of differences in transmission risk during/following incarceration to HCV transmission over 2020–2029. We estimated the past and potential future impact of prison-based opioid agonist therapy (OAT; ~33% coverage) and HCV treatment (1500 treatments in 2019 with 32.9%–83.3% among PWID) on HCV transmission. We estimated the time until HCV incidence reduces by 80% (WHO elimination target) compared to 2016 levels with or without prison-based interventions.

Results
Over 2020–2029, incarceration will contribute 23.0% (17.9–30.5) of new HCV infections. If prison-based interventions had not been implemented since 2010, HCV incidence in 2020 would have been 29.7% (95% credibility interval: 22.4–36.1) higher. If current prison and community HCV treatment rates continue, there is an 98.8% probability that elimination targets will be achieved by 2030, with this decreasing to 10.1% without current prison-based interventions.

Conclusions
Existing prison-based interventions in NSW are critical components of strategies to reduce HCV incidence among PWID. Prison-based interventions are likely to be pivotal for achieving HCV elimination targets among PWID by 2030.
Original languageEnglish
JournalLiver International
Early online date28 Oct 2022
DOIs
Publication statusE-pub ahead of print - 28 Oct 2022

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