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Hepatitis C virus (HCV) infection is endemic in people who inject drugs(PWID), with prevalence estimates above 60 percent for PWID in the UnitedStates. Previous modeling studies suggest that direct acting antiviral (DAA)treatment can lower overall prevalence in this population, but treatment isoften delayed until the onset of advanced liver disease (fibrosis stage 3 orlater) due to cost. Lower cost interventions featuring syringe access (SA) andmedically assisted treatment (MAT) for addiction are known to be less costly,but have shown mixed results in lowering HCV rates below current levels. Littleis known about the potential synergistic effects of combining DAA and MATtreatment, and large-scale tests of combined interventions are rare. Whilesimulation experiments can reveal likely long-term effects, most priorsimulations have been performed on closed populations of model agents--ascenario quite different from the open, mobile populations known to most healthagencies. This paper uses data from the Centers for Disease Control's NationalHIV Behavioral Surveillance project, IDU round 3, collected in New York City in2012 by the New York City Department of Health and Mental Hygiene toparameterize simulations of open populations. Our results show that, in an openpopulation, SA/MAT by itself has only small effects on HCV prevalence, whileDAA treatment by itself can significantly lower both HCV and HCV-relatedadvanced liver disease prevalence. More importantly, the simulation experimentssuggest that cost effective synergistic combinations of the two strategies candramatically reduce HCV incidence. We conclude that adopting SA/MATimplementations alongside DAA interventions can play a critical role inreducing the long-term consequences of ongoing infection.

plos one

Combination interventions for Hepatitis C and Cirrhosis reduction among  people who inject drugs: An agent-based, networked population simulation  experiment