Hannah Fraser1, Natasha K Martin2, Henrikki Brummer-Korvenkontio3, Patrizia Carrieri4, Olav Dalgard5, John Dillon6, David Goldberg7, Sharon Hutchinson8, Marie Jauffret-Roustide9, Martin Kåberg10, Amy A Matser11, Mojca Matičič12, Havard Midgard13, Viktor Mravcik14, Anne Øvrehus15, Maria Prins16, Jens Reimer17, Geert Robaeys18, Bernd Schulte19, Daniela K van Santen20, Ruth Zimmermann21, Peter Vickerman22, Matthew Hickman22. 1. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: hannah.fraser@bristol.ac.uk. 2. Division of Global Public Health, University of California, San Diego, San Diego, CA, USA; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 3. National Institute for Health and Welfare, Helsinki, Finland. 4. Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France. 5. University of Oslo, Oslo, Norway; Akershus University Hospital, Lørenskog, Norway. 6. University of Dundee, Dundee, Scotland, UK. 7. Health Protection Scotland, Glasgow, Scotland, UK. 8. Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Glasgow, Scotland, UK. 9. French Institute for Public Health Surveillance, St. Maurice, France; CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France. 10. Department of Medicine, Huddinge, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 11. Public Health Service of Amsterdam, Amsterdam, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands. 12. University of Ljubljana, Ljubljana, Slovenia; University Medical Centre Ljubljana, Ljubljana, Slovenia. 13. University of Oslo, Oslo, Norway. 14. National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic; Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic. 15. Odense University Hospital, Odense, Denmark. 16. Public Health Service of Amsterdam, Amsterdam, The Netherlands; Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 17. HealthNorth, Bremen, Germany; University of Hamburg, Hamburg, Germany. 18. Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University, Diepenbeek, Belgium; University Hospital Leuven, Leuven, Belgium. 19. University of Hamburg, Hamburg, Germany. 20. Public Health Service of Amsterdam, Amsterdam, The Netherlands. 21. Robert Koch Institute, Berlin, Germany. 22. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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).
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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