Article Dans Une Revue Journal of Hepatology Année : 2018

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

1 Population Health Sciences [Bristol, Royaume-Uni]
2 Division of Global Public Health [San Diego, USA]
3 National Institute for Health and Welfare [Helsinki]
4 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
5 ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille]
6 Akershus University Hospital [Lørenskog]
7 UiO - University of Oslo
8 University of Dundee
9 Health Protection Scotland [Glasgow, Scotland, UK]
10 GCU - Glasgow Caledonian University
11 CERMES3 - UMR 8211 / U988 / UM 7 - CERMES3 - Centre de recherche Médecine, sciences, santé, santé mentale, société
12 Karolinska University Hospital [Stockholm]
13 Karolinska Institutet [Stockholm]
14 Public Health Service of Amsterdam
15 UMCU - University Medical Center [Utrecht]
16 University of Ljubljana
17 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
18 National Monitoring Centre for Drugs and Drug Addiction [Prague, Czech Republic]
19 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
20 VFN - General University Hospital in Prague
21 Odense University Hospital [Odense, Denmark]
22 Academic Medical Centre [Amsterdam]
23 HealthNorth [Bremen, Germany]
24 UHH - Universität Hamburg = University of Hamburg
25 ZOL - Ziekenhuis Oost-Limburg
26 UHasselt - Hasselt University
27 University Hospitals Leuven [Leuven]
28 Robert Koch Institute [Berlin, Germany]
John Dillon

Résumé

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).

Dates et versions

hal-02146845 , version 1 (04-06-2019)

Identifiants

Citer

Hannah Fraser, Natasha K. Martin, Henrikki Brummer-Korvenkontio, Patrizia M. 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, 2018, 68 (3), pp.402-411. ⟨10.1016/j.jhep.2017.10.010⟩. ⟨hal-02146845⟩
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