Adam Trickey1, Hannah Fraser2, Aaron G Lim2, Amy Peacock3, Samantha Colledge3, Josephine G Walker2, Janni Leung4, Jason Grebely5, Sarah Larney3, Natasha K Martin6, Matthew Hickman7, Louisa Degenhardt3, Margaret T May8, Peter Vickerman7. 1. Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK. Electronic address: adam.trickey@bristol.ac.uk. 2. Population Health Sciences, University of Bristol, Bristol, UK. 3. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia. 4. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 5. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. 6. Population Health Sciences, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA. 7. Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK. 8. Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Abstract
BACKGROUND: WHO aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030. Injection drug use is an important risk factor for HCV transmission, but its contribution to country-level and global epidemics is unknown. We estimated the contribution of injection drug use to risk for HCV epidemics globally, regionally, and at country level. METHODS: We developed a dynamic deterministic HCV transmission model to simulate country-level HCV epidemics among people who inject drugs and the general population. Each country's model was calibrated using country-specific data from UN datasets and systematic reviews on the prevalence of HCV and injection drug use. The population attributable fraction of HCV transmission associated with injection drug use was estimated-defined here as the percentage of HCV infections prevented if additional HCV transmission due to injection drug use was removed between 2018 and 2030. FINDINGS: The model included 88 countries (85% of the global population). The model predicted 0·23% (95% credibility interval [CrI] 0·16-0·31) of the global population were injection drug users in 2017, and 8% (5-12) of prevalent HCV infections were among people who currently inject drugs. Globally, if the increased risk for HCV transmission among people who inject drugs was removed, an estimated 43% (95% CrI 25-67) of incident HCV infections would be prevented from 2018 to 2030, varying regionally. This population attributable fraction was higher in high-income countries (79%, 95% CrI 57-97) than in countries of low and middle income (38%, 24-64) and was associated with the percentage of a country's prevalent HCV infections that are among people who inject drugs. INTERPRETATION: Unsafe injecting practices among people who inject drugs contribute substantially to incident HCV infections globally. Any intervention that can reduce HCV transmission among people who inject drugs will have a pronounced effect on country-level incidence of HCV. FUNDING: None.
BACKGROUND: WHO aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030. Injection drug use is an important risk factor for HCV transmission, but its contribution to country-level and global epidemics is unknown. We estimated the contribution of injection drug use to risk for HCV epidemics globally, regionally, and at country level. METHODS: We developed a dynamic deterministic HCV transmission model to simulate country-level HCV epidemics among people who inject drugs and the general population. Each country's model was calibrated using country-specific data from UN datasets and systematic reviews on the prevalence of HCV and injection drug use. The population attributable fraction of HCV transmission associated with injection drug use was estimated-defined here as the percentage of HCV infections prevented if additional HCV transmission due to injection drug use was removed between 2018 and 2030. FINDINGS: The model included 88 countries (85% of the global population). The model predicted 0·23% (95% credibility interval [CrI] 0·16-0·31) of the global population were injection drug users in 2017, and 8% (5-12) of prevalent HCV infections were among people who currently inject drugs. Globally, if the increased risk for HCV transmission among people who inject drugs was removed, an estimated 43% (95% CrI 25-67) of incident HCV infections would be prevented from 2018 to 2030, varying regionally. This population attributable fraction was higher in high-income countries (79%, 95% CrI 57-97) than in countries of low and middle income (38%, 24-64) and was associated with the percentage of a country's prevalent HCV infections that are among people who inject drugs. INTERPRETATION: Unsafe injecting practices among people who inject drugs contribute substantially to incident HCV infections globally. Any intervention that can reduce HCV transmission among people who inject drugs will have a pronounced effect on country-level incidence of HCV. FUNDING: None.
Authors: Louis MacGregor; Natasha K Martin; Christinah Mukandavire; Ford Hickson; Peter Weatherburn; Matthew Hickman; Peter Vickerman Journal: Int J Epidemiol Date: 2017-10-01 Impact factor: 7.196
Authors: Aaron G Lim; Huma Qureshi; Hassan Mahmood; Saeed Hamid; Charlotte F Davies; Adam Trickey; Nancy Glass; Quaid Saeed; Hannah Fraser; Josephine G Walker; Christinah Mukandavire; Matthew Hickman; Natasha K Martin; Margaret T May; Francisco Averhoff; Peter Vickerman Journal: Int J Epidemiol Date: 2018-04-01 Impact factor: 7.196
Authors: Louisa Degenhardt; Amy Peacock; Samantha Colledge; Janni Leung; Jason Grebely; Peter Vickerman; Jack Stone; Evan B Cunningham; Adam Trickey; Kostyantyn Dumchev; Michael Lynskey; Paul Griffiths; Richard P Mattick; Matthew Hickman; Sarah Larney Journal: Lancet Glob Health Date: 2017-10-23 Impact factor: 26.763
Authors: Zoe Ward; Nyashadzaishe Mafirakureva; Jack Stone; Mary Keevans; Graham Betts-Symonds; Desmond Crowley; Tina McHugh; Gordana Avramovic; John S Lambert; Peter Vickerman Journal: Int J Drug Policy Date: 2021-08-17
Authors: Matthew J Akiyama; Nadine Kronfli; Joaquin Cabezas; Yumi Sheehan; Andrew Scheibe; Taha Brahni; Kunal Naik; Pelmos Mashabela; Polin Chan; Niklas Luhmann; Andrew R Lloyd Journal: Lancet Public Health Date: 2022-07
Authors: Lara K Marquez; Javier A Cepeda; Annick Bórquez; Steffanie A Strathdee; Patricia E Gonzalez-Zúñiga; Clara Fleiz; Claudia Rafful; Richard S Garfein; Susan M Kiene; Stephanie Brodine; Natasha K Martin Journal: Int J Drug Policy Date: 2020-03-09
Authors: Adriane Wynn; Samantha Tweeten; Eric McDonald; Wilma Wooten; Kimberley Lucas; Cassandra L Cyr; Maricris Hernandez; Franchesca Ramirez; Corey VanWormer; Scott Suckow; Christian B Ramers; Natasha K Martin Journal: PLoS One Date: 2021-06-09 Impact factor: 3.240
Authors: Jessica L Petrick; Andrea A Florio; Ariana Znaor; David Ruggieri; Mathieu Laversanne; Christian S Alvarez; Jacques Ferlay; Patricia C Valery; Freddie Bray; Katherine A McGlynn Journal: Int J Cancer Date: 2019-11-05 Impact factor: 7.316
Authors: Nyashadzaishe Mafirakureva; Jack Stone; Hannah Fraser; Yvonne Nzomukunda; Aron Maina; Angela W Thiong'o; Kibango Walter Kizito; Esther W K Mucara; C Inés González Diaz; Helgar Musyoki; Bernard Mundia; Peter Cherutich; Mercy Nyakowa; John Lizcano; Nok Chhun; Ann Kurth; Matthew J Akiyama; Wanjiru Waruiru; Parinita Bhattacharjee; Charles Cleland; Dmytro Donchuk; Niklas Luhmann; Anne Loarec; David Maman; Josephine Walker; Peter Vickerman Journal: Addiction Date: 2021-07-28 Impact factor: 6.526
Authors: Jennifer R Havens; Takako Schaninger; Hannah Fraser; Michelle Lofwall; Michele Staton; April M Young; Ardis Hoven; Sharon L Walsh; Peter Vickerman Journal: BMJ Open Date: 2021-07-05 Impact factor: 2.692