Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe

Hannah Fraser, Natasha K. Martin, Henrikki Brummer-Korvenkontio, Patrizia Carrieri, Olav Dalgard, John Dillon, David Goldberg, Sharon Hutchinson, Marie Jauffret-Roustide, Martin Kåberg, Amy A. Matser, Mojca Maticic, Havard Midgard, Viktor Mravcik, Anne Øvrehus, Maria Prins, Jens Reimer, Geert Robaeys, Bernd Schulte, Daniela K. van SantenRuth Zimmermann, Peter Vickerman, Matthew Hickman

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Abstract

Background: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes (NSP) across Europe over the next 10 years. Methods: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence among PWID. Results: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. Current treatment rates using new direct acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia and Amsterdam. Doubling HCV-treatment rates will reduce prevalence in other sites (12-24%, Belgium/Denmark/Hamburg/Norway/Scotland) but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate to substantial increases in current treatment rates are required to achieve the same impact elsewhere, from 1.4-3 times (Czech Republic/France), 5-17 times 5 (France/Scotland/Hamburg/Norway/Denmark/Belgium/Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. Conclusions: Scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.
Original languageEnglish
Pages (from-to)402-411
Number of pages10
JournalJournal of Hepatology
Volume68
Issue number3
Early online date25 Oct 2017
DOIs
Publication statusPublished - Mar 2018

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Hepacivirus
Opiate Substitution Treatment
Pharmaceutical Preparations
Syringes
Slovenia
Sweden
Needles
Czech Republic
Denmark
Therapeutics
Finland
Norway
Antiviral Agents
Belgium
Scotland
Chronic Hepatitis C
France
Incidence

Keywords

  • HCV treatment
  • HCV transmission
  • injecting drug users

Cite this

Fraser, H., Martin, N. K., Brummer-Korvenkontio, H., Carrieri, P., Dalgard, O., Dillon, J., ... Hickman, M. (2018). Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. Journal of Hepatology, 68(3), 402-411. https://doi.org/10.1016/j.jhep.2017.10.010
Fraser, Hannah ; Martin, Natasha K. ; Brummer-Korvenkontio, Henrikki ; Carrieri, Patrizia ; Dalgard, Olav ; Dillon, John ; Goldberg, David ; Hutchinson, Sharon ; Jauffret-Roustide, Marie ; Kåberg, Martin ; Matser, Amy A. ; Maticic, Mojca ; Midgard, Havard ; Mravcik, Viktor ; Øvrehus, Anne ; Prins, Maria ; Reimer, Jens ; Robaeys, Geert ; Schulte, Bernd ; van Santen, Daniela K. ; Zimmermann, Ruth ; Vickerman, Peter ; Hickman, Matthew. / Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. In: Journal of Hepatology. 2018 ; Vol. 68, No. 3. pp. 402-411.
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abstract = "Background: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes (NSP) across Europe over the next 10 years. Methods: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence among PWID. Results: At baseline, chronic HCV prevalence varied from <25{\%} (Slovenia/Czech Republic) to >55{\%} (Finland/Sweden), and <2{\%} (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5{\%} (Slovenia/Czech Republic) of chronically infected PWID were treated annually. Current treatment rates using new direct acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63{\%}) in 10 years in Czech Republic, Slovenia and Amsterdam. Doubling HCV-treatment rates will reduce prevalence in other sites (12-24{\%}, Belgium/Denmark/Hamburg/Norway/Scotland) but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80{\%} coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79{\%}) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate to substantial increases in current treatment rates are required to achieve the same impact elsewhere, from 1.4-3 times (Czech Republic/France), 5-17 times 5 (France/Scotland/Hamburg/Norway/Denmark/Belgium/Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80{\%} in all sites reduces treatment scale-up needed by 20-80{\%}. Conclusions: Scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.",
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Fraser, H, Martin, NK, Brummer-Korvenkontio, H, Carrieri, P, Dalgard, O, Dillon, J, Goldberg, D, Hutchinson, S, Jauffret-Roustide, M, Kåberg, M, Matser, AA, Maticic, M, Midgard, H, Mravcik, V, Øvrehus, A, Prins, M, Reimer, J, Robaeys, G, Schulte, B, van Santen, DK, Zimmermann, R, Vickerman, P & Hickman, M 2018, 'Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe', Journal of Hepatology, vol. 68, no. 3, pp. 402-411. https://doi.org/10.1016/j.jhep.2017.10.010

Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. / Fraser, Hannah; Martin, Natasha K.; Brummer-Korvenkontio, Henrikki ; Carrieri, Patrizia; Dalgard, Olav; Dillon, John; Goldberg, David; Hutchinson, Sharon; Jauffret-Roustide, Marie; Kåberg, Martin; Matser, Amy A.; Maticic, Mojca; Midgard, Havard; Mravcik, Viktor; Øvrehus, Anne; Prins, Maria; Reimer, Jens; Robaeys, Geert; Schulte, Bernd; van Santen, Daniela K.; Zimmermann, Ruth; Vickerman, Peter; Hickman, Matthew.

In: Journal of Hepatology, Vol. 68, No. 3, 03.2018, p. 402-411.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe

AU - Fraser, Hannah

AU - Martin, Natasha K.

AU - Brummer-Korvenkontio, Henrikki

AU - Carrieri, Patrizia

AU - Dalgard, Olav

AU - Dillon, John

AU - Goldberg, David

AU - Hutchinson, Sharon

AU - Jauffret-Roustide, Marie

AU - Kåberg, Martin

AU - Matser, Amy A.

AU - Maticic, Mojca

AU - Midgard, Havard

AU - Mravcik, Viktor

AU - Øvrehus, Anne

AU - Prins, Maria

AU - Reimer, Jens

AU - Robaeys, Geert

AU - Schulte, Bernd

AU - van Santen, Daniela K.

AU - Zimmermann, Ruth

AU - Vickerman, Peter

AU - Hickman, Matthew

N1 - Acceptance email in SAN AAM: 12m embargo Copyright held by client org. ET 8-1-18

PY - 2018/3

Y1 - 2018/3

N2 - Background: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes (NSP) across Europe over the next 10 years. Methods: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence among PWID. Results: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. Current treatment rates using new direct acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia and Amsterdam. Doubling HCV-treatment rates will reduce prevalence in other sites (12-24%, Belgium/Denmark/Hamburg/Norway/Scotland) but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate to substantial increases in current treatment rates are required to achieve the same impact elsewhere, from 1.4-3 times (Czech Republic/France), 5-17 times 5 (France/Scotland/Hamburg/Norway/Denmark/Belgium/Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. Conclusions: Scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.

AB - Background: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes (NSP) across Europe over the next 10 years. Methods: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence among PWID. Results: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. Current treatment rates using new direct acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia and Amsterdam. Doubling HCV-treatment rates will reduce prevalence in other sites (12-24%, Belgium/Denmark/Hamburg/Norway/Scotland) but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate to substantial increases in current treatment rates are required to achieve the same impact elsewhere, from 1.4-3 times (Czech Republic/France), 5-17 times 5 (France/Scotland/Hamburg/Norway/Denmark/Belgium/Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. Conclusions: Scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.

KW - HCV treatment

KW - HCV transmission

KW - injecting drug users

U2 - 10.1016/j.jhep.2017.10.010

DO - 10.1016/j.jhep.2017.10.010

M3 - Article

VL - 68

SP - 402

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IS - 3

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Fraser H, Martin NK, Brummer-Korvenkontio H, Carrieri P, Dalgard O, Dillon J et al. Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. Journal of Hepatology. 2018 Mar;68(3):402-411. https://doi.org/10.1016/j.jhep.2017.10.010