Abstract
Background and aims
Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States (US). We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting.
Design
An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from a HIV-outbreak investigation in Indiana.
Setting
Scott County, Indiana (population 24,181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence amongst PWID in 2015
Participants
PWID
Measurements
Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programs (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without retreatment of reinfections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting.
Findings
To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 25% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 15%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (20%) need treatment annually. These treatment requirements are 3-fold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment.
Conclusions
Combined scale-up of hepatitis C virus (HCV) treatment and prevention interventions is needed to decrease the increasing burden of HCV incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States (US). We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting.
Design
An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from a HIV-outbreak investigation in Indiana.
Setting
Scott County, Indiana (population 24,181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence amongst PWID in 2015
Participants
PWID
Measurements
Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programs (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without retreatment of reinfections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting.
Findings
To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 25% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 15%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (20%) need treatment annually. These treatment requirements are 3-fold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment.
Conclusions
Combined scale-up of hepatitis C virus (HCV) treatment and prevention interventions is needed to decrease the increasing burden of HCV incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
| Original language | English |
|---|---|
| Pages (from-to) | 173-182 |
| Number of pages | 10 |
| Journal | Addiction |
| Volume | 113 |
| Issue number | 1 |
| Early online date | 20 Sept 2017 |
| DOIs | |
| Publication status | Published - 1 Jan 2018 |
Keywords
- Hepatitis C
- mathematical modelling
- needle syringe programmes
- opioid substitution therapy
- people who inject drugs
- prescription opioid
Access to Document
- Full-text PDF (accepted author manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wiley at http://onlinelibrary.wiley.com/doi/10.1111/add.13948/abstract;jsessionid=8B9A91541EC66E03661C7BB32E72E1D9.f04t04. Please refer to any applicable terms of use of the publisher.