scholarly journals Modelling the Impact of Prevention and Treatment Interventions on HIV and Hepatitis C Virus Transmission Among People Who Inject Drugs in Kenya

2021 ◽  
Author(s):  
Jack Stone ◽  
Hannah Fraser ◽  
Josephine G Walker ◽  
Nyashadzaishe Mafirakureva ◽  
Bernard Mundia ◽  
...  
Keyword(s):  
Sexual Risk ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Coastal Region ◽  
Hiv Infections ◽  
Hiv Incidence ◽  
Hcv Treatment ◽  
Opioid Substitution Therapy ◽  
Substantial Impact ◽  
The Impact

AbstractBackgroundPeople who inject drugs (PWID) in Kenya have a high prevalence of HIV (14-26%) and HCV (11-36%). Needle and syringe programmes (NSP) and antiretroviral therapy (ART) have high coverage among PWID, while HCV treatment and opioid substitution therapy (OST) access is low.MethodsA dynamic model of HIV (sexual and injecting-related) and HCV (injecting-related) transmission among PWID was calibrated using Bayesian methods to data from Nairobi and the Coastal region. We projected the impact of existing coverage levels of interventions (ART: 64-66%; OST: 4-7%; NSP: 54-56%) in each setting, and the impact over 2020-2030 of increasing the coverage of OST (50%) and NSP (75%; ‘full HR’), ART (UNAIDS 90-90-90 target), HCV treatment (1000 over 5 years), and reducing HIV sexual risk by 75%. We estimated HCV treatment levels needed to reduce HCV incidence by 90% with or without full HR.FindingsSince 2013, HR has averted 15.1-20.6% (range in medians across settings) of HIV infections and 29.0-31.6% of HCV infections across Nairobi and the Coastal region, with most impact being due to NSP. Conversely, ART has only averted <5% of HIV infections since 2004 because of sub-optimal viral suppression (28-48%). Going forward, Full HR and ART could reduce HIV incidence by 58.2-62.0% and HCV incidence by 62.6-81.6% by 2030 across these settings. If sexual risk is also reduced, HIV incidence would reduce by 77.1-81.4%. Alongside full HR, treating 896 PWID over 2020-2025 could reduce HCV incidence by 90% by 2030.InterpretationExisting interventions have had moderate impact on HIV and HCV transmission in Kenya, but may have substantial impact if scaled-up. However, to achieve HIV and HCV elimination, reductions in sexual risk are needed and a scale-up in HCV treatment.FundingGlobal Fund, MDM

scholarly journals Declines in HIV incidence among men and women in a South African population-based cohort

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Alain Vandormael ◽  
Adam Akullian ◽  
Mark Siedner ◽  
Tulio de Oliveira ◽  
Till Bärnighausen ◽  
...  
Keyword(s):  
South African ◽  
Scale Up ◽  
Hiv Infections ◽  
Population Based ◽  
Hiv Incidence ◽  
Prevention Services ◽  
Incidence Trends ◽  
The Past ◽  
Massive Scale ◽  
The Impact

AbstractOver the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.

scholarly journals Modeling Combination Hepatitis C Virus Treatment and Prevention Strategies in a Network of People Who Inject Drugs in the United States

2020 ◽  
Author(s):  
Alexei Zelenev ◽  
Jianghong Li ◽  
Portia Shea ◽  
Robert Hecht ◽  
Frederick L Altice
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
The United States ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Hcv Prevalence ◽  
The Impact

Abstract Background Hepatitis C virus (HCV) treatment as prevention (TasP) strategies can contribute to HCV microelimination, yet complimentary interventions such as opioid agonist therapies (OAT) with methadone or buprenorphine and syringe services programs (SSPs) may improve the prevention impact. This modeling study estimates the impact of scaling up the combination of OAT and SSPs with HCV TasP in a network of people who inject drugs (PWID) in the United States. Methods Using empirical data from Hartford, Connecticut, we deployed a stochastic block model to simulate an injection network of 1574 PWID. We used a susceptible-infected model for HCV and human immunodeficiency virus to evaluate the effectiveness of several HCV TasP strategies, including in combination with OAT and SSP scale-up, over 20 years. Results At the highest HCV prevalence (75%), when OAT coverage is increased from 10% to 40%, combined with HCV treatment of 10% per year and SSP scale up to 40%, the time to achieve microelimination is reduced from 18.4 to 11.6 years. At the current HCV prevalence (60%), HCV TasP strategies as low as 10% coverage per year may achieve HCV microelimination within 10 years, with minimal impact from additional OAT scale-up. Strategies based on mass initial HCV treatment (50 per 100 PWID the first year followed by 5 per 100 PWID thereafter) were most effective in settings with HCV prevalence of 60% or lower. Conclusions Scale-up of HCV TasP is the most effective strategy for microelimination of HCV. OAT scale-up, however, scale-up may be synergistic toward achieving microelimination goals when HCV prevalence exceeds 60% and when HCV treatment coverage is 10 per 100 PWID per year or lower.

scholarly journals Modelling the impact of a national scale-up of interventions on hepatitis C virus transmission among people who inject drugs in Scotland

Addiction ◽  
2018 ◽  
Vol 113 (11) ◽  
pp. 2118-2131 ◽  
Author(s):  
Hannah Fraser ◽  
Christinah Mukandavire ◽  
Natasha K. Martin ◽  
David Goldberg ◽  
Norah Palmateer ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Virus Transmission ◽  
National Scale ◽  
The Impact ◽  
Hepatitis C Virus Transmission

Incarceration of People who inject Drugs – Modelling its Role in HCV Transmission and the Impact of Scaled-Up HCV Treatment in Prisons

2016 ◽  
Vol 64 (2) ◽  
pp. S811
Author(s):  
J. Stone ◽  
N.K. Martin ◽  
M. Hickman ◽  
S. Hutchinson ◽  
E. Aspinall ◽  
...  
Keyword(s):  
People Who Inject Drugs ◽  
Hcv Treatment ◽  
Hcv Transmission ◽  
The Impact

scholarly journals Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Addiction ◽  
2017 ◽  
Vol 112 (7) ◽  
pp. 1302-1314 ◽  
Author(s):  
Jack Stone ◽  
Natasha K. Martin ◽  
Matthew Hickman ◽  
Sharon J. Hutchinson ◽  
Esther Aspinall ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Hcv Treatment ◽  
Hcv Transmission ◽  
The Impact

scholarly journals The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

2021 ◽  
Vol 5 ◽  
pp. 15
Author(s):  
Eline L. Korenromp ◽  
Anna Bershteyn ◽  
Edina Mudimu ◽  
Renay Weiner ◽  
Collen Bonecwe ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Hiv Transmission ◽  
Scale Up ◽  
Household Survey ◽  
Hiv Infections ◽  
Treatment Needs ◽  
Medical Male Circumcision ◽  
Hiv Epidemic ◽  
The Impact

Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.

scholarly journals Evaluating the impact and cost-effectiveness of scaling-up HCV treatment among people who inject drugs in Ukraine

2021 ◽  
Author(s):  
Jack Stone ◽  
Josephine G Walker ◽  
Sandra Bivegete ◽  
Adam Trickey ◽  
Charles Chasela ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
People Who Inject Drugs ◽  
Cost Effective ◽  
Treatment Rate ◽  
Hcv Treatment ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Hcv Transmission ◽  
Preventative Interventions ◽  
The Impact

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.

Estimating the impact of HIV combination prevention in men who have sex with men, the Bangkok MSM Cohort Study, Thailand

2020 ◽  
Vol 31 (7) ◽  
pp. 637-641
Author(s):  
Sarika Pattanasin ◽  
Betsy L Cadwell ◽  
Dawn K Smith ◽  
Wichuda Sukwicha ◽  
Philip A Mock ◽  
...  
Keyword(s):  
Condom Use ◽  
Hiv Infections ◽  
Substantial Impact ◽  
Combination Prevention ◽  
Hiv Epidemic ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Combined Interventions

In Thailand, pre-exposure prophylaxis (PrEP) is recommended for human immunodeficiency virus (HIV) prevention among at-risk men who have sex with men (MSM). We modeled the impact of PrEP and condom use as independent and combined interventions on the estimated number of HIV infections among a hypothetical population of 10,000 MSM in Bangkok, Thailand. Our model demonstrated a 92% (95% confidence interval 89.7, 94.2) reduction in HIV infections among Thai MSM who took daily PrEP and self-reported using condoms correctly and consistently (100% condom use). Increased use of PrEP and condoms likely would have a substantial impact on the HIV epidemic in Thailand.

scholarly journals People Who Inject Drugs and have tuberculosis: Opioid Substitution Therapy improves treatment outcomes in Ukraine

2021 ◽  
Vol 15 (09.1) ◽  
pp. 51S-57S
Author(s):  
Tetiana Fomenko ◽  
Anna Meteliuk ◽  
Larysa Korinchuk ◽  
Olga Denisiuk ◽  
Garry Aslanyan ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
People Who Inject Drugs ◽  
Treatment Success ◽  
Scale Up ◽  
Drug Resistant ◽  
Health Coverage ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Tb Treatment ◽  
Opioid Substitution

Introduction: Opioid substitution therapy (OST) is one of the pillars of harm reduction strategies for People Who Inject Drugs (PWID). It should be an integral part of tuberculosis (TB) care to increase the uptake, compliance and effectiveness of treatment and also curtail risk behaviors. We aimed to compare TB treatment outcomes in relation to OST among PWID in six regions of Ukraine. Methodology: A retrospective cohort study using routine programmatic data from centers offering integrated TB and OST (December 2016 – May 2020). OST involved use of methadone or buprenorphine. TB treatment outcomes were standardized. Results: Of 228 PWID (85% male) diagnosed with TB, 104 (46%) had drug-sensitive and 124 (64%) drug-resistant TB. The majority had pulmonary TB (95%), 64 (28%) were HCV-positive and 179 (78%) were HIV-positive, 91% of the latter were also on antiretroviral therapy. There were 114 (50%) PWID with TB on OST. For drug-sensitive TB (n=104), treatment success was significantly higher (61%) in those on adjunctive OST than those not on OST (42%, P<0.001). Similarly, for drug-resistant TB (n=124) treatment success was also significantly higher when individuals were on OST (43%) compared to when not on OST (26%, P<0.001). Conclusions: This operational research study shows that OST is associated with significantly improved treatment success in PWID and can contribute to achieving Universal Health Coverage and the WHO Flagship Initiative “Find.Treat.All. #End TB”. We advocate for the scale-up of this intervention in Ukraine.

Sign in / Sign up

Export Citation Format

Share Document