Impact Of Scaling-Up HCVPrevention And Treatment Interventions Among People Who Inject Drugs In San Francisco Vs Perry County Kentucky

Author: Fraser H, Vellozzi C, Hoerger TJ, Evans J, Kral AH, Havens J, Young A, Handanagic S, Hariri S, Barbosa C, Hickman M, Leib A, Martin NK,Nerlander L, Raymond HF, Page K, Zibbell J, Ward J, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2017

Background: Transmission of hepatitis C virus (HCV) infection is increasing among people who inject drugs (PWID) in the US. Availability of harm reduction interventions such as medication-assisted treatment (MAT) and syringe service programs (SSP) varies widely across the US; we investigate the impact of scaling-up these interventions with new direct-acting-antiviral HCV-treatment.

Methods: We calibrated two HCV-transmission models among PWID to data from Perry County (PC) and San Francisco (SF). Both settings have >50% HCV sero-prevalence among PWID, but compared to PC, SF has a greater proportion with recent (last 3-6 months) access to MAT (6%vs12%) or SSP (0%vs85%). We assume MAT and SSP alone or combined reduce HCV transmission risk (by 50%, 44%, or 71%, respectively) based on a recent Cochrane review. Additionally, PC is rural with a young expanding PWID population, while urban SF has an aging population. We estimate the proportion of HCV-infected PWID needing HCV-treatment annually to reduce HCV prevalence and incidence by 90% by 2030, with and without MAT and SSP scale-up to 50% coverage amongst PWID (unless existing coverage higher in SF).

Results: With no intervention scale-up, HCV prevalence and incidence will increase in PC over 2017-2030 (52.4% to 59.9% and 17.1 to 19.4 per 100pyrs, respectively), while they will decrease in SF (73.7% to 68.1% and 10.9 to 9.7 per 100pyrs). With concurrent scale-up of MAT and SSP, 8% of HCV-infected PWID need treatment annually in PC to reduce prevalence and incidence by 90% by 2030; 13% if MAT and SSP are not scaled-up. In SF, due to high existing SSP coverage, the proportion needing treatment annually is similar (8-9%) irrespective of MAT scale-up.

Conclusions: Achievable scale-up of HCV-treatment, alongside MAT and SSP scale-up in PC could substantially reduce prevalence and incidence of HCV. Similar interventions may benefit other areas of the US.

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