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. 2012;7(4):e34548.
doi: 10.1371/journal.pone.0034548. Epub 2012 Apr 12.

Treatment of hepatitis C as prevention: a modeling case study in Vietnam

Nicolas Durier  1 , Chi Nguyen, Lisa J White
Affiliations

Treatment of hepatitis C as prevention: a modeling case study in Vietnam

Nicolas Durier et al. PLoS One. 2012.

Abstract

Background: Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50-90% of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored.

Methods and findings: In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75% of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50% coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values.

Conclusions: In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission and prevalence.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Model schematic.
S: Susceptible individuals; AA: Acute asymptomatic cases; AS: Acute symptomatic cases; TA: Treated Acute symptomatic cases; R: Recovered infections; C: Chronic infections; TC: Treated Chronic infections.
Figure 2
Figure 2. Projected preventive effect of increasing hepatitis C treatment coverage (Scenario A).
Panel A): Reduction of anti-HCV antibody prevalence following treatment introduction and scale up to a 25%, 50% and 75% coverage level. Panel B): Reduction of prevalence of HCV true viremic chronic infections. Panel C): new infections averted per every 100 treatment courses of chronically infected cases.
Figure 3
Figure 3. Projected preventive effect of treating earlier into infection (Scenario B).
Panel A): Reduction of anti-HCV antibody prevalence following treatment of 50% of chronically infected cases, 4, 3, 2 and 1 year into infection, and 75% of acute symptomatic cases. Panel B): effect on chronic HCV viremia prevalence. Panel C): new infections averted per every 100 treatment courses initiated.
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