Modelling the impact of scaling up HCV case finding and treatment for people who inject drugs in England.

Author: Zoe Ward, Hannah Fraser, Adam Trickey, Joanne Kesten, Andy Gibson, Leila Reid, Fiona Gordon, Stuart McPherson, Stephen Ryder, Andrew Ustianowski, Alec Miners, Jack Williams, Graham Foster, Monica Desai, Sema Mandal, Laura Coughlan, Ruth Simmons, Ellen Heinsbroek, Sara Croxford, Ross Harris, Matthew Hickman, Peter Vickerman

Theme: Epidemiology & Public Health Research Year: 2023

People who inject drugs (PWID) in the UK are disproportionately affected by Hepatitis C (HCV). England aims to eliminate HCV as a public health threat by 2030, through decreasing chronic HCV among PWID by 80% from 2015 baseline or to incidence <2 per 100 person-years. We assess whether existing strategies will achieve these elimination goals in England.

A dynamic HCV transmission model among PWID, including prison and drug treatment centres (DTCs), was used to project the impact of existing HCV testing and treatment services in four England regions: Bristol and Severn; Nottingham; Greater Manchester and Eastern Cheshire; and Northeast and North Cumbria. The model includes the pathway from testing to treatment in prison, DTCs, and other settings. Data on testing and treatment and yearly bio-behavioural surveys among PWID was used to parameterise and calibrate the model. Model projections were used to determine whether each region will reach the WHO elimination targets by 2030.

Data suggest that 1041, 1004, and 1426 treatments (694 per year among an estimated 35900 PWID) were undertaken in prisons, DTC, and other settings respectively, between 2015-2019 across these four regions. The time from diagnosis to treatment decreased from >1 year to <3 months in all settings and regions. This treatment scale-up is projected to have decreased chronic prevalence across these regions by 30-43% and incidence by 28-42% over 2015-2020 (range of medians). Assuming continuation of these treatment rates from 2020, chronic prevalence will decrease by 61-84% by 2030 and incidence by 59-84% to 1.5-4.7 per 100 person-years (range of medians). Credibility intervals around these projections suggest the WHO targets may be reached in three regions.

Our modelling suggests that levels of HCV treatment among PWID in England may be sufficient to reach the WHO elimination targets by 2030, but further scale-up may be needed.

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