Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting?

Aims: To project the impact of scaling-up oral anti-viral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programmes to achieve specific targets and to examine whether hepatitis C virus (HCV) elimination among PWID is possible in this high-prevalence setting. Design: A dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for re-infection following treatment. Setting/participants: The population of 8300 PWID in Athens Metropolitan area. Measurements: Reduction in HCV prevalence and incidence in 2030 compared with 2016. Findings: Moderate expansion of HCV treatment (treating 4–8% of PWID/year), with a simultaneous increase of 2%/year in harm reduction coverage (from 44 to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46.2–94.8% in 2030, compared with 2016. CHC prevalence would reduce to below 10% within the next 4–5 years if annual HCV treatment numbers were increased up to 16–20% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates. Conclusions: Based on theoretical model projections, scaled-up hepatitis C virus treatment and harm reduction interventions could achieve major reductions in hepatitis C virus incidence and prevalence among people who inject drugs in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4–5 years by increasing treatment to more than 16% of people who inject drugs per year combined with moderate increases in harm reduction coverage.