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. 2018 May 17;113(9):1727-1738.
doi: 10.1111/add.14217. Online ahead of print.

Impact of current and scaled-up levels of hepatitis C prevention and treatment interventions for people who inject drugs in three UK settings-what is required to achieve the WHO's HCV elimination targets?

Zoe Ward  1 , Lucy Platt  2 , Sedona Sweeney  2 , Vivian D Hope  3   4 , Lisa Maher  5 , Sharon Hutchinson  6   7 , Norah Palmateer  6   7 , Josie Smith  8 , Noel Craine  8 , Avril Taylor  9 , Natasha Martin  10 , Rachel Ayres  11 , John Dillon  12 , Matthew Hickman  1 , Peter Vickerman  1
Affiliations

Impact of current and scaled-up levels of hepatitis C prevention and treatment interventions for people who inject drugs in three UK settings-what is required to achieve the WHO's HCV elimination targets?

Zoe Ward et al. Addiction. .

Abstract

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.

Keywords: HCV treatment scale-up; hepatitis C virus; mathematical model; needle and syringe provision; opioid substitution therapy; people who inject drugs.

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Figures

Figure 1
Figure 1
Schematics of different model components. (a) Schematic of injecting duration and infection components of model. Susceptible individuals are free from disease and upon infection move to the chronically infected category. Successfully treated individuals move back into the susceptible category. Injecting duration is modelled as three categories; recently initiated people who inject drugs (PWID) (denoted recent PWID, < 3 years), non‐recent PWID (≥ 3 and < 10 years) and long‐term PWID (≥ 10 years), with PWID transitioning through these categories at rates τi, where i = 1, 2 for recent and non‐recent injectors, respectively. Injectors cease injecting (cessation or death) at rate μi where i = 1, 2, 3 for recent (< 3 years of injecting), non‐recent (≥ 3 years and < 10 years) and long‐term injectors (> = 10 years) respectively. (b) Schematic of intervention component of model. It is assumed the recruitment rates β and η are independent of the current intervention state. OST = opioid substitution therapy; HCNSP = high coverage needle and syringe provision (defined as at least one clean needle for every injection). (c) Schematic of disease progression component of the model. Each of the disease states is stratified by injecting duration n, risk category m, OST category i and needle and syringe provision (NSP) category j. Progression through the disease states occurs at a rate determined by the current disease state, as are the disease related death rates. Metavir states F0, F1 (mild HCV disease), F2, F3 (moderate HCV disease), compensated cirrhosis (also denoted as metavir state F4), decompensated cirrhosis, hepatocellular carcinoma (HCC), liver transplant and post‐liver transplant. All states have a cessation rate from injecting and a non‐disease related background death rate. Infection can occur between all disease states, but not shown for clarity. [Colour figure can be viewed at http://wileyonlinelibrary.com]
Figure 2
Figure 2
Impact of each intervention scenario on hepatitis C virus (HCV) incidence and prevalence in Bristol (a,b), Walsall (c,d) and Dundee (e,f). Thick solid line is median baseline scenario, with shaded region the 95% credible intervals. The black points with thin whiskers are the data points [with 95% credible interval (CrI)] that were not fitted to, whereas the black points with thick whiskers are the data points used for model calibration. (a,b) Bristol incidence and prevalence. (c,d) Dundee incidence and prevalence. (e,f) Walsall incidence and prevalence
Figure 3
Figure 3
Relative increase in new hepatitis C virus (HCV) infections (2016–30) resulting from removing existing coverage levels of needle and syringe provision (NSP), opioid substitution therapy (OST), both NSP and OST, HCV treatment of people who inject drugs (PWID) or all interventions in each city. The box‐plots signify the uncertainty (middle line is the median, the limits of the box are 25and 75% percentiles and the whiskers 2.5 and 97.5% percentiles)
Figure 4
Figure 4
Required annual number of hepatitis C virus (HCV) treatments per 1000 PWID needed to reduce incidence by 90%, with or without high coverage needle syringe provision (HCNSP) and opioid substitution therapy (OST) scaling up to 80% coverage. The box‐plots signify the uncertainty in the model projections (middle line is the median, the limits of the box are 25 and 75% percentiles and the whiskers 2.5 and 97.5% percentiles). The dashed boxes show the uncertainty range in the current treatment rate per 1000 PWID in each setting
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References

    1. World Health Organization (WHO) . Combating Hepatitis B and C to Reach Elimination by 2030. Geneva: WHO; 2016.
    1. Public Health England . Hepatitis C in the UK 2015 report. London, UK: Public Health England; 2015.
    1. Harris R. J., Ramsay M., Hope V. D., Brant L., Hickman M., Foster G. R. et al Hepatitis C prevalence in England remains low and varies by ethnicity: an updated evidence synthesis. Eur J Public Health 2012; 22: 187–192. - PubMed
    1. Palmateer N., Kimber J., Hickman M., Hutchinson S., Rhodes T., Goldberg D. Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews. Addiction 2010; 105: 844–859. - PubMed
    1. Turner K. M., Hutchinson S., Vickerman P., Hope V., Craine N., Palmateer N. et al The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction 2011; 106: 1978–1988. - PubMed

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