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Scaling‐up HCV prevention and treatment interventions in rural United States—model projections for tackling an increasing epidemic
Author(s) -
Fraser Hannah,
Zibbell Jon,
Hoerger Thomas,
Hariri Susan,
Vellozzi Claudia,
Martin Natasha K.,
Kral Alex H.,
Hickman Matthew,
Ward John W.,
Vickerman Peter
Publication year - 2018
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13948
Subject(s) - medicine , psychological intervention , epidemiology , incidence (geometry) , treatment as prevention , environmental health , population , hepatitis c , transmission (telecommunications) , rural area , demography , human immunodeficiency virus (hiv) , virology , viral load , antiretroviral therapy , pathology , psychiatry , physics , electrical engineering , sociology , optics , engineering
Background and aims Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale‐up of HCV treatment with or without scale‐up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. Design An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana. Setting Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015. Participants PWID. Measurements Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling‐up syringe service programmes (SSPs) and medication‐assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re‐treatment of re‐infections, and whether greater intervention scale‐up was required due to the increasing epidemic in this setting. Findings To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale‐up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV‐treated annually. However, with MAT and SSP scaled‐up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled‐up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. Conclusions Combined scale‐up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.