Abstract
BackgroundWidely access to interferon-free direct-acting antiviral regimens (IFN-free DAA) is poised to dramatically change the impact of the HCV epidemic among people who inject drugs (PWID). We evaluated the long-term effect of increasing HCV testing, treatment and engagement into harm-reduction activities, focused on active PWID, on the HCV epidemic in British Columbia (BC), Canada.MethodsWe built a compartmental model of HCV disease transmission stratified by disease progression, transmission risk, and fibrosis level. We explored the effect of: (1) Increasing treatment rates from 8 to 20, 40 and 80 per 1000 infected PWID/year; (2) Increasing treatment eligibility based on fibrosis level; (3) Maximizing the effect of testing by performing it immediately upon ending the acute phase; (4) Increasing access to harm-reduction activities to reduce the risk of re-infection; (5) Different HCV antiviral regimens on the Control Reproduction Number R c. We assessed the impact of these interventions on incidence, prevalence and mortality from 2016 to 2030.ResultsOf all HCV antiviral regimens, only IFN-free DAAs offered a high chance of disease elimination (i.e. R c < 1), but it would be necessary to substantially increase the current low testing and treatment rates. Assuming a treatment rate of 80 per 1000 infected PWID per year, coupled with a high testing rate, the incidence rate, at the end of 2030, could decrease from 92.9 per 1000 susceptible PWID per year (Status Quo) to 82.8 (by treating only PWID with fibrosis level F 2 and higher) or to 65.5 (by treating PWID regardless of fibrosis level). If PWID also had access to increased harm-reduction activities, the incidence rate further decreased to 53.1 per 1000 susceptible PWID per year. We also obtained significant decreases in prevalence and mortality at the end of 2030.ConclusionsThe combination of increased access to HCV testing, highly efficacious antiviral treatment and harm-reduction programs can substantially decrease the burden of the HCV epidemic among PWID. However, unless we increase the current levels of treatment and testing, the HCV epidemic among PWID in BC, and in other parts of the world with similar epidemiological background, will remain a substantial public health concern for many years.
Highlights
The burden of hepatitis C virus (HCV) infection remains a major public health challenge, among people who inject drugs (PWID), who have an estimated global HCV prevalence of 67% [1]
The combination of increased access to HCV testing, highly efficacious antiviral treatment and harm-reduction programs can substantially decrease the burden of the HCV epidemic among PWID
Unless we increase the current levels of treatment and testing, the HCV epidemic among PWID in British Columbia (BC), and in other parts of the world with similar epidemiological background, will remain a substantial public health concern for many years
Summary
The burden of hepatitis C virus (HCV) infection remains a major public health challenge, among people who inject drugs (PWID), who have an estimated global HCV prevalence of 67% [1]. There is still a large number of individuals unaware that they are infected with HCV (50% in the United States, >60% in Europe and 26% in cohort studies in Vancouver Canada), and a large number of individuals with no or limited access to treatment (
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