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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.

Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, Vickerman P - Clin. Infect. Dis. (2013)

Bottom Line: Scaling up OST and HCNSP substantially reduces the treatment rate required to achieve specific HCV prevalence reductions.If coverage of OST and HCNSP is 50% at baseline, similar prevalence reductions require higher treatment rates for the same OST and HCNSP coverage.Combining antiviral treatment with OST with HCNSP is critical for achieving substantial reductions (>50%) in HCV chronic prevalence over 10 years.

View Article: PubMed Central - PubMed

Affiliation: School of Social and Community Medicine, University of Bristol, UK. natasha.martin@bristol.ac.uk

ABSTRACT

Background: Interventions such as opiate substitution therapy (OST) and high-coverage needle and syringe programs (HCNSP) cannot substantially reduce hepatitis C virus (HCV) prevalence among people who inject drugs (PWID). HCV antiviral treatment may prevent onward transmission. We project the impact of combining OST, HCNSP, and antiviral treatment on HCV prevalence/incidence among PWID.

Methods: An HCV transmission model among PWID was used to project the combinations of OST, HCNSP, and antiviral treatment required to achieve different prevalence and incidence reductions within 10 years for 3 chronic prevalence scenarios and the impact of HCV treatment if only delivered through OST programs. Multivariate and univariate sensitivity analyses were performed.

Results: Large reductions (>45%) in HCV chronic prevalence over 10 years require HCV antiviral treatment. Scaling up OST and HCNSP substantially reduces the treatment rate required to achieve specific HCV prevalence reductions. If OST and HCNSP coverage were increased to 40% each (no coverage at baseline), then annually treating 10, 23, or 42 per 1000 PWID over 10 years would halve prevalence for 20%, 40%, or 60% baseline chronic HCV prevalences, respectively. Approximately 30% fewer treatments are necessary with new direct-acting antivirals. If coverage of OST and HCNSP is 50% at baseline, similar prevalence reductions require higher treatment rates for the same OST and HCNSP coverage.

Conclusions: Combining antiviral treatment with OST with HCNSP is critical for achieving substantial reductions (>50%) in HCV chronic prevalence over 10 years. Empirical studies are required on how best to scale up antiviral treatment and combine treatment with other interventions.

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Related in: MedlinePlus

Minimum coverage of opiate substitution therapy/high-coverage needle and syringe programs (OST and HCNSP) required if antiviral treatment (pegylated interferon and ribavirin [peg-IFN + RBV]) is delivered alongside OST. Figures show the minimum coverage of OST and HCNSP required (y-axis) for various desired relative prevalence reductions at 10 years (x-axis) with the 20%, 40%, and 60% baseline hepatitis C virus (HCV) chronic prevalence settings if all infected people who inject drugs (PWID) on OST are treated annually, limited by HCV prevalence (A) or 5% of PWID on OST are treated annually (B). Projections used the median estimates for efficacy of OST, HCNSP, and peg-IFN + RBV from Table 1.
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CIT296F3: Minimum coverage of opiate substitution therapy/high-coverage needle and syringe programs (OST and HCNSP) required if antiviral treatment (pegylated interferon and ribavirin [peg-IFN + RBV]) is delivered alongside OST. Figures show the minimum coverage of OST and HCNSP required (y-axis) for various desired relative prevalence reductions at 10 years (x-axis) with the 20%, 40%, and 60% baseline hepatitis C virus (HCV) chronic prevalence settings if all infected people who inject drugs (PWID) on OST are treated annually, limited by HCV prevalence (A) or 5% of PWID on OST are treated annually (B). Projections used the median estimates for efficacy of OST, HCNSP, and peg-IFN + RBV from Table 1.

Mentions: Figure 3 shows the minimum coverage of OST and HCNSP required (no coverage at baseline) to achieve different relative reductions in prevalence at 10 years, while assuming either there are no limits to treatment capacity/uptake within OST (all infected PWID on OST are treated each year) or that 5% of PWID on OST are treated annually. If all infected PWID on OST can be treated annually, halving prevalence in 10 years requires 18%–24% coverage of OST and HCNSP, whereas higher coverage levels are required if only 5% of PWID on OST are annually treated (25%–58% OST and HCNSP).Figure 3.


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.

Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, Vickerman P - Clin. Infect. Dis. (2013)

Minimum coverage of opiate substitution therapy/high-coverage needle and syringe programs (OST and HCNSP) required if antiviral treatment (pegylated interferon and ribavirin [peg-IFN + RBV]) is delivered alongside OST. Figures show the minimum coverage of OST and HCNSP required (y-axis) for various desired relative prevalence reductions at 10 years (x-axis) with the 20%, 40%, and 60% baseline hepatitis C virus (HCV) chronic prevalence settings if all infected people who inject drugs (PWID) on OST are treated annually, limited by HCV prevalence (A) or 5% of PWID on OST are treated annually (B). Projections used the median estimates for efficacy of OST, HCNSP, and peg-IFN + RBV from Table 1.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3722076&req=5

CIT296F3: Minimum coverage of opiate substitution therapy/high-coverage needle and syringe programs (OST and HCNSP) required if antiviral treatment (pegylated interferon and ribavirin [peg-IFN + RBV]) is delivered alongside OST. Figures show the minimum coverage of OST and HCNSP required (y-axis) for various desired relative prevalence reductions at 10 years (x-axis) with the 20%, 40%, and 60% baseline hepatitis C virus (HCV) chronic prevalence settings if all infected people who inject drugs (PWID) on OST are treated annually, limited by HCV prevalence (A) or 5% of PWID on OST are treated annually (B). Projections used the median estimates for efficacy of OST, HCNSP, and peg-IFN + RBV from Table 1.
Mentions: Figure 3 shows the minimum coverage of OST and HCNSP required (no coverage at baseline) to achieve different relative reductions in prevalence at 10 years, while assuming either there are no limits to treatment capacity/uptake within OST (all infected PWID on OST are treated each year) or that 5% of PWID on OST are treated annually. If all infected PWID on OST can be treated annually, halving prevalence in 10 years requires 18%–24% coverage of OST and HCNSP, whereas higher coverage levels are required if only 5% of PWID on OST are annually treated (25%–58% OST and HCNSP).Figure 3.

Bottom Line: Scaling up OST and HCNSP substantially reduces the treatment rate required to achieve specific HCV prevalence reductions.If coverage of OST and HCNSP is 50% at baseline, similar prevalence reductions require higher treatment rates for the same OST and HCNSP coverage.Combining antiviral treatment with OST with HCNSP is critical for achieving substantial reductions (>50%) in HCV chronic prevalence over 10 years.

View Article: PubMed Central - PubMed

Affiliation: School of Social and Community Medicine, University of Bristol, UK. natasha.martin@bristol.ac.uk

ABSTRACT

Background: Interventions such as opiate substitution therapy (OST) and high-coverage needle and syringe programs (HCNSP) cannot substantially reduce hepatitis C virus (HCV) prevalence among people who inject drugs (PWID). HCV antiviral treatment may prevent onward transmission. We project the impact of combining OST, HCNSP, and antiviral treatment on HCV prevalence/incidence among PWID.

Methods: An HCV transmission model among PWID was used to project the combinations of OST, HCNSP, and antiviral treatment required to achieve different prevalence and incidence reductions within 10 years for 3 chronic prevalence scenarios and the impact of HCV treatment if only delivered through OST programs. Multivariate and univariate sensitivity analyses were performed.

Results: Large reductions (>45%) in HCV chronic prevalence over 10 years require HCV antiviral treatment. Scaling up OST and HCNSP substantially reduces the treatment rate required to achieve specific HCV prevalence reductions. If OST and HCNSP coverage were increased to 40% each (no coverage at baseline), then annually treating 10, 23, or 42 per 1000 PWID over 10 years would halve prevalence for 20%, 40%, or 60% baseline chronic HCV prevalences, respectively. Approximately 30% fewer treatments are necessary with new direct-acting antivirals. If coverage of OST and HCNSP is 50% at baseline, similar prevalence reductions require higher treatment rates for the same OST and HCNSP coverage.

Conclusions: Combining antiviral treatment with OST with HCNSP is critical for achieving substantial reductions (>50%) in HCV chronic prevalence over 10 years. Empirical studies are required on how best to scale up antiviral treatment and combine treatment with other interventions.

Show MeSH
Related in: MedlinePlus