Impact of current and scaled up levels of Hepatitis C (HCV) prevention and treatment interventions for people who inject drugs in three UK settings – what is required to achieve the WHO’s HCV elimination targets?

Zoe Ward, Lucy Platt, Sedona Sweeney, Vivien Hope, Lisa Maher, Sharon Hutchinson, Norah Palmateer, Josie Smith, Noel Craine, Avril Taylor, Natasha Martin, Rachel Ayres, John Dillon, Matthew Hickman, Peter Vickerman

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Abstract

Aims: We estimate the impact of existing high coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three United Kingdom (UK) settings. We determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organisation (WHO) target of reducing HCV incidence by 90% by 2030.

Design HCV transmission modelling utilising UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition

Setting Three UK cities with varying HCV antibody prevalence (Bristol 60%, Dundee 46%, Walsall 32%), OST (72-81%), and HCNSP coverage (28-56%).

Measurements Relative change in new HCV infections over 2016-2030 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.

Findings Removing HCNSP or OST would increase the number of new HCV infections over 2016-2030 by 23-64% and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29% or 49% reduction in Bristol and Walsall, respectively, whereas Dundee achieves a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently 1-3 and 6-12 treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.

Conclusions Current opioid substitution therapy and high coverage needle and syringe provision coverage is averting substantial Hepatitis C transmission in the United Kingdom. Maintaining this coverage while initiating current injectors on treatment can reduce incidence by 90% by 2030.
Original languageEnglish
Pages (from-to)1727-1738
Number of pages12
JournalAddiction
Volume113
Issue number9
Early online date17 May 2018
DOIs
Publication statusPublished - Sep 2018

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Opiate Substitution Treatment
Hepatitis C
Hepacivirus
Pharmaceutical Preparations
Syringes
Needles
Therapeutics
Virus Diseases
Incidence
United Kingdom
Hepatitis C Antibodies

Keywords

  • hepatitis C prevention
  • virology
  • WHO

Cite this

Ward, Zoe ; Platt, Lucy ; Sweeney, Sedona ; Hope, Vivien ; Maher, Lisa ; Hutchinson, Sharon ; Palmateer, Norah ; Smith, Josie ; Craine, Noel ; Taylor, Avril ; Martin, Natasha ; Ayres, Rachel ; Dillon, John ; Hickman, Matthew ; Vickerman, Peter. / Impact of current and scaled up levels of Hepatitis C (HCV) prevention and treatment interventions for people who inject drugs in three UK settings – what is required to achieve the WHO’s HCV elimination targets?. In: Addiction. 2018 ; Vol. 113, No. 9. pp. 1727-1738.
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title = "Impact of current and scaled up levels of Hepatitis C (HCV) prevention and treatment interventions for people who inject drugs in three UK settings – what is required to achieve the WHO’s HCV elimination targets?",
abstract = "Aims: We estimate the impact of existing high coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three United Kingdom (UK) settings. We determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organisation (WHO) target of reducing HCV incidence by 90{\%} by 2030.Design HCV transmission modelling utilising UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition Setting Three UK cities with varying HCV antibody prevalence (Bristol 60{\%}, Dundee 46{\%}, Walsall 32{\%}), OST (72-81{\%}), and HCNSP coverage (28-56{\%}).Measurements Relative change in new HCV infections over 2016-2030 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.Findings Removing HCNSP or OST would increase the number of new HCV infections over 2016-2030 by 23-64{\%} and 92-483{\%}, respectively. Conversely, scaling-up these interventions to 80{\%} coverage could achieve a 29{\%} or 49{\%} reduction in Bristol and Walsall, respectively, whereas Dundee achieves a 90{\%} decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently 1-3 and 6-12 treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.Conclusions Current opioid substitution therapy and high coverage needle and syringe provision coverage is averting substantial Hepatitis C transmission in the United Kingdom. Maintaining this coverage while initiating current injectors on treatment can reduce incidence by 90{\%} by 2030.",
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Impact of current and scaled up levels of Hepatitis C (HCV) prevention and treatment interventions for people who inject drugs in three UK settings – what is required to achieve the WHO’s HCV elimination targets? / Ward, Zoe; Platt, Lucy; Sweeney, Sedona; Hope, Vivien; Maher, Lisa; Hutchinson, Sharon; Palmateer, Norah; Smith, Josie; Craine, Noel; Taylor, Avril; Martin, Natasha ; Ayres, Rachel; Dillon, John; Hickman, Matthew; Vickerman, Peter.

In: Addiction, Vol. 113, No. 9, 09.2018, p. 1727-1738.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of current and scaled up levels of Hepatitis C (HCV) prevention and treatment interventions for people who inject drugs in three UK settings – what is required to achieve the WHO’s HCV elimination targets?

AU - Ward, Zoe

AU - Platt, Lucy

AU - Sweeney, Sedona

AU - Hope, Vivien

AU - Maher, Lisa

AU - Hutchinson, Sharon

AU - Palmateer, Norah

AU - Smith, Josie

AU - Craine, Noel

AU - Taylor, Avril

AU - Martin, Natasha

AU - Ayres, Rachel

AU - Dillon, John

AU - Hickman, Matthew

AU - Vickerman, Peter

N1 - Acceptance in SAN OA article

PY - 2018/9

Y1 - 2018/9

N2 - Aims: We estimate the impact of existing high coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three United Kingdom (UK) settings. We determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organisation (WHO) target of reducing HCV incidence by 90% by 2030.Design HCV transmission modelling utilising UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition Setting Three UK cities with varying HCV antibody prevalence (Bristol 60%, Dundee 46%, Walsall 32%), OST (72-81%), and HCNSP coverage (28-56%).Measurements Relative change in new HCV infections over 2016-2030 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.Findings Removing HCNSP or OST would increase the number of new HCV infections over 2016-2030 by 23-64% and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29% or 49% reduction in Bristol and Walsall, respectively, whereas Dundee achieves a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently 1-3 and 6-12 treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.Conclusions Current opioid substitution therapy and high coverage needle and syringe provision coverage is averting substantial Hepatitis C transmission in the United Kingdom. Maintaining this coverage while initiating current injectors on treatment can reduce incidence by 90% by 2030.

AB - Aims: We estimate the impact of existing high coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three United Kingdom (UK) settings. We determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organisation (WHO) target of reducing HCV incidence by 90% by 2030.Design HCV transmission modelling utilising UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition Setting Three UK cities with varying HCV antibody prevalence (Bristol 60%, Dundee 46%, Walsall 32%), OST (72-81%), and HCNSP coverage (28-56%).Measurements Relative change in new HCV infections over 2016-2030 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target.Findings Removing HCNSP or OST would increase the number of new HCV infections over 2016-2030 by 23-64% and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29% or 49% reduction in Bristol and Walsall, respectively, whereas Dundee achieves a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently 1-3 and 6-12 treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up.Conclusions Current opioid substitution therapy and high coverage needle and syringe provision coverage is averting substantial Hepatitis C transmission in the United Kingdom. Maintaining this coverage while initiating current injectors on treatment can reduce incidence by 90% by 2030.

KW - hepatitis C prevention

KW - virology

KW - WHO

U2 - 10.1111/add.14217

DO - 10.1111/add.14217

M3 - Article

VL - 113

SP - 1727

EP - 1738

JO - Addiction

JF - Addiction

SN - 0965-2140

IS - 9

ER -