Abstract
BackgroundThe introduction of highly effective direct-acting antiviral (DAA) therapy for hepatitis C has led to calls to eliminate it as a public health threat through treatment-as-prevention. Recent studies suggest it is possible to develop a vaccine to prevent hepatitis C. Using a mathematical model, we examined the potential impact of a hepatitis C vaccine on the feasibility and cost of achieving the global WHO elimination target of an 80% reduction in incidence by 2030 in the era of DAA treatment.MethodsThe model was calibrated to 167 countries and included two population groups (people who inject drugs (PWID) and the general community), features of the care cascade, and the coverage of health systems to deliver services. Projections were made for 2018–2030.ResultsThe optimal incidence reduction strategy was to implement test and treat programmes among PWID, and in settings with high levels of community transmission undertake screening and treatment of the general population. With a vaccine available, the optimal strategy was to include vaccination within test and treat programmes, in addition to vaccinating adolescents in settings with high levels of community transmission. Of the 167 countries modelled, between 0 and 48 could achieve an 80% reduction in incidence without a vaccine. This increased to 15–113 countries if a 75% efficacious vaccine with a 10-year duration of protection were available. If a vaccination course cost US$200, vaccine use reduced the cost of elimination for 66 countries (40%) by an aggregate of US$7.4 (US$6.6–8.2) billion. For a US$50 per course vaccine, this increased to a US$9.8 (US$8.7–10.8) billion cost reduction across 78 countries (47%).ConclusionsThese findings strongly support the case for hepatitis C vaccine development as an urgent public health need, to ensure hepatitis C elimination is achievable and at substantially reduced costs for a majority of countries.
Highlights
The introduction of highly effective direct-acting antiviral (DAA) therapy for hepatitis C has led to calls to eliminate it as a public health threat through treatment-as-prevention
In settings where the prevalence of hepatitis C among People who inject drugs (PWID) is less than approximately 50%, mathematical models show that treatment-as-prevention can be effective at reducing incidence as long as treatment scale-up is rapid, has sufficiently high coverage, and is supported by harm
For 69 (41%) of the countries modelled, a vaccine reduced the testing frequency required among PWID
Summary
The introduction of highly effective direct-acting antiviral (DAA) therapy for hepatitis C has led to calls to eliminate it as a public health threat through treatment-as-prevention. We examined the potential impact of a hepatitis C vaccine on the feasibility and cost of achieving the global WHO elimination target of an 80% reduction in incidence by 2030 in the era of DAA treatment. In settings where the prevalence of hepatitis C among PWID is less than approximately 50%, mathematical models show that treatment-as-prevention can be effective at reducing incidence as long as treatment scale-up is rapid, has sufficiently high coverage, and is supported by harm. If the prevalence of hepatitis C among PWID is extremely high (greater than approximately 75%, such as Fiji, Indonesia, Iran, Italy, Malaysia, Mexico, and Pakistan [9]), it is unlikely that even three monthly testing of PWID would be sufficient to achieve major reductions in incidence [4]. Settings with high prevalence among PWID are likely to need significant additional prevention measures to achieve hepatitis C elimination
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