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

J Hepatol. 2018 Mar;68(3):402-411. doi: 10.1016/j.jhep.2017.10.010. Epub 2018 Jan 8.

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).

Keywords: Direct-acting antivirals; Hepatitis C; Opioid substitution therapy; PWID.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Disease Transmission, Infectious / prevention & control
  • Disease Transmission, Infectious / statistics & numerical data
  • Europe / epidemiology
  • Hepatitis C, Chronic* / drug therapy
  • Hepatitis C, Chronic* / epidemiology
  • Hepatitis C, Chronic* / prevention & control
  • Humans
  • Incidence
  • Models, Theoretical
  • Needle-Exchange Programs / methods
  • Needle-Exchange Programs / organization & administration
  • Needs Assessment
  • Opiate Substitution Treatment / methods*
  • Prevalence
  • Substance Abuse, Intravenous* / complications
  • Substance Abuse, Intravenous* / epidemiology
  • Substance Abuse, Intravenous* / prevention & control

Substances

  • Antiviral Agents