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

Autor: Fraser H; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: hannah.fraser@bristol.ac.uk., Martin NK; Division of Global Public Health, University of California, San Diego, San Diego, CA, USA; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK., Brummer-Korvenkontio H; National Institute for Health and Welfare, Helsinki, Finland., Carrieri P; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France., Dalgard O; University of Oslo, Oslo, Norway; Akershus University Hospital, Lørenskog, Norway., Dillon J; University of Dundee, Dundee, Scotland, UK., Goldberg D; Health Protection Scotland, Glasgow, Scotland, UK., Hutchinson S; Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Glasgow, Scotland, UK., Jauffret-Roustide M; French Institute for Public Health Surveillance, St. Maurice, France; CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France., Kåberg M; Department of Medicine, Huddinge, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden., Matser AA; Public Health Service of Amsterdam, Amsterdam, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands., Matičič M; University of Ljubljana, Ljubljana, Slovenia; University Medical Centre Ljubljana, Ljubljana, Slovenia., Midgard H; University of Oslo, Oslo, Norway., Mravcik V; National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic; Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic., Øvrehus A; Odense University Hospital, Odense, Denmark., Prins M; Public Health Service of Amsterdam, Amsterdam, The Netherlands; Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Reimer J; HealthNorth, Bremen, Germany; University of Hamburg, Hamburg, Germany., Robaeys G; Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University, Diepenbeek, Belgium; University Hospital Leuven, Leuven, Belgium., Schulte B; University of Hamburg, Hamburg, Germany., van Santen DK; Public Health Service of Amsterdam, Amsterdam, The Netherlands., Zimmermann R; Robert Koch Institute, Berlin, Germany., Vickerman P; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK., Hickman M; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: Journal of hepatology [J Hepatol] 2018 Mar; Vol. 68 (3), pp. 402-411. Date of Electronic Publication: 2018 Jan 08.
DOI: 10.1016/j.jhep.2017.10.010
Abstrakt: Background & Aims: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) 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 parameterised an HCV transmission model to setting-specific data that project 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. The 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 the 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 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and 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: The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.
Lay Summary: Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).
(Copyright © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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