Investigating the epidemiology of hepatitis C virus (HCV) infection in different settings around the world

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Hepatitis C virus (HCV) is a bloodborne virus affecting the liver. An estimated 71 million people are infected globally and around 400,000 people die annually from HCV-related complications. Direct-acting antivirals (DAAs), highly effective treatments for HCV, were first approved in the US in 2011. Subsequently, in 2016 the WHO developed a Global Health Sector Strategy calling for the global elimination of HCV as a public health threat by 2030. To eliminate HCV requires an understanding of its epidemiology and how it varies across settings, which I investigate in this thesis.

The first part of my thesis involves the use of data from two general population household serosurveys to investigate the risk factors associated with prevalent HCV infections in two high prevalence settings: Pakistan and Punjab state, India. I find various factors associated with HCV infection, including the number of childbirths, or the number of medical injections received; information that is useful to policy makers planning HCV screening strategies in these settings. Additionally, in Pakistan I estimate the contribution of medical, community, and socio-economic risk factors to the HCV epidemic, finding that they all have
a large contribution.

The second part of my thesis involves the development of a global model of the HCV epidemics in 88 countries across the world. I use this model to estimate the contribution of injecting drug use (IDU) to country-level HCV epidemics, as well as regionally and globally. I show that, globally, IDU contributes nearly half of all HCV transmission. I use the global model to also estimate the benefit of treatment as prevention for different subgroups of infected individuals. Globally, I find that, of the infected subgroups investigated, the highest number of infections averted are achieved through treating people who inject drugs, while a
treat-all strategy will also achieve appreciable prevention benefits.
Date of Award28 Nov 2019
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorMatt Hickman (Supervisor), Peter T Vickerman (Supervisor) & Margaret T May (Supervisor)

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