Scaling-up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States – a Rural and Urban Comparison

Hannah Fraser, Claudia Vellozzi, Thomas Hoerger, Jennifer Evans, Alex H. Kral, Jennifer Havens, April Young, Jack Stone, Senad Handanagic, Susan Hariri, Carolina Barbosa, Matthew Hickman, Alyssa Leib, Natasha Martin, Lina Nerlander, Henry Raymond, Kimberly Page, Jon Zibbell, John Ward, Peter Vickerman

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

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In the U.S. Hepatitis C virus (HCV) transmission is increasing among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modelling, we investigate the impact of scaling-up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky (PC), and San Francisco, California (SF), where HCV sero-prevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban SF (established community) than rural PC (young, expanding community). We model the proportion of HCV-infected PWID needing HCV-treatment annually to reduce HCV-incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (PC only) from 2017. With current MAT&SSP coverage during 2017-2030, HCV-incidence will increase in PC (21.3 to 22.6 per 100 person-years (/100pyrs)) and decrease in SF (12.9 to 11.9/100pyrs). With concurrent MAT&SSP scale-up, 5%/year of HCV-infected PWID need HCV-treatment in PC to achieve incidence targets; 13%/year without MAT&SSP scale-up. In SF, a similar proportion need HCV-treatment (10%/year) irrespective of MAT scale-up. Reaching the same impact by 2025 requires increases in treatment rates of 45-82%. Achievable provision of HCV-treatment, alongside MAT&SSP scale-up (PC) and MAT scale-up (SF), could reduce HCV-incidence.
Original languageEnglish
Article numberkwz097
Pages (from-to)1539–1551
Number of pages13
JournalAmerican Journal of Epidemiology
Issue number8
Publication statusPublished - 31 May 2019


  • direct-acting-antiviral HCV-treatment
  • Hepatitis C virus
  • medication-assisted treatment
  • modelling
  • persons who inject drugs
  • syringe service programs

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