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

Hannah Fraser 1 Natasha K. Martin 2 Henrikki Brummer-Korvenkontio 3 Patrizia Carrieri 4, 5 Olav Dalgard 6, 7 John Dillon 8 David Goldberg 9 Sharon Hutchinson 10, 9 Marie Jauffret-Roustide 11 Martin Kaberg 12, 13 Amy A. Matser 14, 15 Mojca Maticic 16, 17 Havard Midgard 7 Viktor Mravcik 18, 19, 20 Anne Ovrehus 21 Maria Prins 14, 22 Jens Reimer 23, 24 Geert Robaeys 25, 26, 27 Bernd Schulte 24 Daniela K. Santen 14 Ruth Zimmermann 28 Peter Vickerman 1 Matthew Hickman 1
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).
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Submitted on : Tuesday, June 4, 2019 - 11:47:52 AM
Last modification on : Wednesday, October 14, 2020 - 3:49:40 AM

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Hannah Fraser, Natasha K. Martin, Henrikki Brummer-Korvenkontio, Patrizia Carrieri, Olav Dalgard, et al.. Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. Journal of Hepatology, Elsevier, 2018, 68 (3), pp.402-411. ⟨10.1016/j.jhep.2017.10.010⟩. ⟨hal-02146845⟩

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