TY - JOUR
T1 - Impact of current and scaled-up levels of hepatitis C prevention and treatment interventions for people who inject drugs in three UK settings
T2 - what is required to achieve the WHO's HCV elimination targets?
AU - Ward, Zoe
AU - Platt, Lucy
AU - Sweeney, Sedona
AU - Hope, Vivian D.
AU - Maher, Lisa
AU - Hutchinson, Sharon
AU - Palmateer, Norah
AU - Smith, Josie
AU - Craine, Noel
AU - Taylor, Avril
AU - Martin, Natasha
AU - Ayres, Rachel
AU - Dillon, John
AU - Hickman, Matthew
AU - Vickerman, Peter
N1 - This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health En-gland. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Re-search (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. ac-knowledge support from the National Institute of Health Re-search Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC).
PY - 2018/9
Y1 - 2018/9
N2 - Aims: To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three UK settings and to determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organization (WHO) target of reducing HCV incidence by 90% by 2030.Design: HCV transmission modelling using UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition.Setting and Participants: Three UK cities with varying chronic HCV prevalence (Bristol 45%, Dundee 26%, Walsall 19%), OST (72-81%) and HCNSP coverage (28-56%).Measurements: Relative change in new HCV infections throughout 2016-30 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.Findings: Removing HCNSP or OST would increase the number of new HCV infections throughout 2016 to 2030 by 23-64 and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29 or 49% reduction in Bristol and Walsall, respectively, whereas Dundee may achieve a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently two and nine treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.Conclusions: Current opioid substitution therapy and high-coverage needle and syringe provision coverage is averting substantial hepatitis C transmission in the United Kingdom. Maintaining this coverage while getting current drug injectors onto treatment can reduce incidence by 90% by 2030.
AB - Aims: To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three UK settings and to determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organization (WHO) target of reducing HCV incidence by 90% by 2030.Design: HCV transmission modelling using UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition.Setting and Participants: Three UK cities with varying chronic HCV prevalence (Bristol 45%, Dundee 26%, Walsall 19%), OST (72-81%) and HCNSP coverage (28-56%).Measurements: Relative change in new HCV infections throughout 2016-30 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.Findings: Removing HCNSP or OST would increase the number of new HCV infections throughout 2016 to 2030 by 23-64 and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29 or 49% reduction in Bristol and Walsall, respectively, whereas Dundee may achieve a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently two and nine treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.Conclusions: Current opioid substitution therapy and high-coverage needle and syringe provision coverage is averting substantial hepatitis C transmission in the United Kingdom. Maintaining this coverage while getting current drug injectors onto treatment can reduce incidence by 90% by 2030.
KW - HCV treatment scale-up
KW - hepatitis C virus
KW - mathematical model
KW - needle and syringe provision
KW - opioid substitution therapy
KW - people who inject drugs
UR - http://www.scopus.com/inward/record.url?scp=85047486630&partnerID=8YFLogxK
U2 - 10.1111/add.14217
DO - 10.1111/add.14217
M3 - Article
C2 - 29774607
SN - 0965-2140
VL - 113
SP - 1727
EP - 1738
JO - Addiction
JF - Addiction
IS - 9
ER -
