Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe"

Hannah Fraser, Natasha K. Martin, Henrikki Brummer-Korvenkontio, Patrizia Carrieri, Olav Dalgard, John Dillon, David Goldberg, Sharon Hutchinson, Marie Jauffret-Roustide, Martin Kåberg, Amy A. Matser, Mojca Matičič, Havard Midgard, Viktor Mravcik, Anne Øvrehus, Maria Prins, Jens Reimer, Geert Robaeys, Bernd Schulte, Daniela K. van SantenRuth Zimmermann, Peter Vickerman, Matthew Hickman

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Abstract

Background & Aims: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. Methods: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. Results: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38–63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12–24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18–79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5–17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20–80%. Conclusions: The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. Lay summary: Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).

Original languageEnglish
Pages (from-to)402-411
Number of pages10
JournalJournal of Hepatology
Volume68
Issue number3
Early online date25 Oct 2017
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Direct-acting antivirals
  • Hepatitis C
  • Opioid substitution therapy
  • PWID

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    Fraser, H., Martin, N. K., Brummer-Korvenkontio, H., Carrieri, P., Dalgard, O., Dillon, J., Goldberg, D., Hutchinson, S., Jauffret-Roustide, M., Kåberg, M., Matser, A. A., Matičič, M., Midgard, H., Mravcik, V., Øvrehus, A., Prins, M., Reimer, J., Robaeys, G., Schulte, B., ... Hickman, M. (2018). Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe". Journal of Hepatology, 68(3), 402-411. https://doi.org/10.1016/j.jhep.2017.10.010