Combination Interventions to Prevent HCV Transmission Among People Who Inject Drugs: Modeling the Impact of Antiviral Treatment, Needle and Syringe Programs, and Opiate Substitution Therapy

Introduction People who inject drugs (PWID) in Ukraine have a high prevalence of hepatitis C virus (HCV). Since 2015, PWID have been receiving HCV treatment, but their impact and cost-effectiveness has not been estimated. Methods We developed a dynamic model of HIV and HCV transmission among PWID in Ukraine, incorporating ongoing HCV treatment (5,933 treatments) over 2015-2021; 46.1% among current PWID. We estimated the impact of these treatments and different treatment scenarios over 2021-2030: continuing recent treatment rates (2,394 PWID/year) with 42.5/100% among current PWID, or treating 5,000/10,000 current PWID/year. We also estimated the treatment rate required to decrease HCV incidence by 80% if preventative interventions are scaled-up or not. Required costs were collated from previous studies in Ukraine. We estimated the incremental cost-effectiveness ratio (ICER) of the HCV treatments undertaken in 2020 (1,059) by projecting the incremental costs and disability adjusted life years (DALYs) averted over 2020-2070 (3% discount rate) compared to a counterfactual scenario without treatment from 2020 onwards. Results On average, 0.4% of infections among PWID were treated annually over 2015-2021, without which HCV incidence would have been 0.6% (95%CrI: 0.3-1.0%) higher in 2021. Continuing existing treatment rates could reduce HCV incidence by 10.2% (7.8-12.5%) or 16.4% (12.1-22.0%) by 2030 if 42.5% or 100% of treatments are given to current PWID, respectively. HCV incidence could reduce by 29.3% (20.7-44.7%) or 93.9% (54.3-99.9%) by 2030 if 5,000 or 10,000 PWID are treated annually. To reduce incidence by 80% by 2030, 19,275 (15,134-23,522) annual treatments are needed among current PWID, or 17,955 (14,052-21,954) if preventative interventions are scaled-up. The mean ICER was US$828.8/DALY averted; cost-effective at a willingness-to-pay threshold of US$3,096/DALY averted (1xGDP). Implications Existing HCV treatment is cost-effective but has had little preventative impact due to few current PWID being treated. Further treatment expansion for current PWID could significantly reduce HCV incidence.

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What is the impact of antiviral treatment for people who inject drugs on the overall number of new hepatitis C infections within the population of injecting drug users?

http://isrctn.com/ ◽

10.1186/isrctn72038467 ◽

2019 ◽

Author(s):

Jade Meadows

Keyword(s):

Hepatitis C ◽

Drug Users ◽

People Who Inject Drugs ◽

Antiviral Treatment ◽

Injecting Drug Users ◽

The Impact

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Dynamic modelling of hepatitis C transmission among people who inject drugs: A tool to support WHO elimination targets

10.1101/460550 ◽

2018 ◽

Author(s):

Theresa Stocks ◽

Leah J. Martin ◽

Sharon Kühlmann-Berenzon ◽

Tom Britton

Keyword(s):

Hepatitis C ◽

People Who Inject Drugs ◽

High Income ◽

Disease Stage ◽

Data Set ◽

True Incidence ◽

Needle Exchange Programs ◽

Shiny App ◽

Hcv Transmission ◽

The Impact

AbstractTo reach the WHO goal of hepatitis C elimination, it is essential to identify the number of people unaware of their hepatitis C virus (HCV) infection and to investigate the effect of interventions on the disease transmission dynamics. In many middle- and high-income countries, one of the primary routes of HCV transmission is via contaminated needles shared by people who inject drugs (PWIDs). However, substantial underreporting combined with high uncertainty regarding the size of this difficult to reach population, makes it challenging to estimate the core indicators recommended by the WHO. To help enable countries to monitor their progress towards the elimination goal, we present a novel multi-layered dynamic transmission model for HCV transmission within a PWID population. The model explicitly accounts for disease stage (acute and chronic), injection drug use status (active and former PWIDs), status of diagnosis (diagnosed and undiagnosed) and country of disease acquisition (domestic or abroad). First, based on this model, and using routine surveillance data, we estimate the number of undiagnosed PWIDs, the true incidence, the average time until diagnosis, the reproduction numbers and associated uncertainties. Second, we examine the impact of two interventions on disease dynamics: 1) direct-acting antiviral drug treatment, and 2) needle exchange programs. To make the model accessible to relevant users and to support communication of our results to public health decision makers, the model and its output are made available through a Shiny app. As a proof of concept, we illustrate our results for a specific data set; however, through the app our model can be easily adapted to other high-income countries with similar transmission patterns among PWIDs where the disease is endemic.

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“I want to stop using drugs. What should I do next?”

HIV ◽

10.1093/med/9780190088316.003.0023 ◽

2020 ◽

pp. 211-218

Author(s):

Rick Elion

Keyword(s):

People Who Inject Drugs ◽

The United States ◽

Oral Medications ◽

Psychosocial Skills ◽

B Virus ◽

Key Driver ◽

Opiate Substitution Therapy ◽

Living With Hiv ◽

The Impact ◽

Actual Selection

The care of individuals living with HIV who inject drugs involves a unique subset of patients. People who inject drugs have become a key driver of new cases in the United States as the opiate epidemic has impacted such a large group of the population. The proliferation of oral narcotics prompted increased use of injectable opiates as the sale of oral medications became both more expensive and difficult. This epidemic has been confluent with the development of addiction, which can be very hard to treat, as well as the impact of adherence of active addiction on antiretroviral therapy medications. The challenge to the clinician caring for people who inject drugs is to become fluent in the treatment of HIV, hepatitis C virus, and hepatitis B virus, the psychosocial skills of dealing with addiction, and opiate substitution therapy. The chapter outlines approaches to care for this population that can assist with these clinical challenges as the actual selection of medications will not be unique for this population. Therefore, different approaches are being learned, not different sets of medications (except for opiate substitution treatment).

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The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence

Addiction ◽

10.1111/j.1360-0443.2011.03515.x ◽

2011 ◽

Vol 106 (11) ◽

pp. 1978-1988 ◽

Cited By ~ 230

Author(s):

Katy M. E. Turner ◽

Sharon Hutchinson ◽

Peter Vickerman ◽

Vivian Hope ◽

Noel Craine ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Drug Users ◽

Injecting Drug Users ◽

Substitution Therapy ◽

Opiate Substitution Therapy ◽

The Impact

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Editorial Commentary:The Impact of Opiate Substitution Therapy and Highly Active Antiretroviral Therapy on Mortality Risk Among People Who Inject Drugs

Clinical Infectious Diseases ◽

10.1093/cid/civ481 ◽

2015 ◽

Vol 61 (7) ◽

pp. 1166-1168 ◽

Cited By ~ 3

Author(s):

Matthew Hickman ◽

Peter Vickerman ◽

Louisa Degenhardt

Keyword(s):

Antiretroviral Therapy ◽

Mortality Risk ◽

Highly Active Antiretroviral Therapy ◽

People Who Inject Drugs ◽

Substitution Therapy ◽

Highly Active ◽

Opiate Substitution Therapy

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Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Journal of Clinical Medicine ◽

10.3390/jcm10174001 ◽

2021 ◽

Vol 10 (17) ◽

pp. 4001

Author(s):

Francesco Foschi ◽

Alberto Borghi ◽

Alberto Grassi ◽

Arianna Lanzi ◽

Elvira Speranza ◽

...

Keyword(s):

People Who Inject Drugs ◽

Antiviral Treatment ◽

Intervention Strategy ◽

Real Life ◽

Linkage To Care ◽

Virologic Response ◽

Serious Adverse Events ◽

Opioid Substitution Treatment ◽

The Impact

Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.

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