Potential impact of curative and preventive interventions toward hepatitis C elimination in people who inject drugs-A network modeling study.

Autor: Zhu L; Department of Global Health and Population, Harvard T. H. Chan School of Public, Boston, MA, USA; Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA. Electronic address: linzhu1@stanford.edu., Thompson WW; Prevention Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, GA, USA., Hagan L; Prevention Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, GA, USA., Randall LM; Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA., Rudolph AE; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA., Young AM; Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA., Havens JR; Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA., Salomon JA; Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA., Linas BP; Section of Infectious Disease, Department of Medicine, Boston Medical Center, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Jazyk: angličtina
Zdroj: The International journal on drug policy [Int J Drug Policy] 2024 Aug; Vol. 130, pp. 104539. Date of Electronic Publication: 2024 Jul 20.
DOI: 10.1016/j.drugpo.2024.104539
Abstrakt: Background: Injection-equipment-sharing networks play an important role in hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Direct-acting antiviral (DAA) treatments for HCV infection and interventions to prevent HCV transmission are critical components of an overall hepatitis C elimination strategy, but how they contribute to the elimination outcomes in different PWID network settings are unclear.
Methods: We developed an agent-based network model of HCV transmission through the sharing of injection equipment among PWID and parameterized and calibrated the model with rural PWID data in the United States. We modeled curative and preventive interventions at annual coverage levels of 12.5 %, 25 %, or 37.5 % (cumulative percentage of eligible individuals engaged), and two allocation approaches: random vs targeting PWID with more injection partners (hereafter 'degree-based'). We compared the impact of these intervention strategies on prevalence and incidence of HCV infections. We conducted sensitivity analysis on key parameters governing the effects of curative and preventive interventions and PWID network characteristics.
Results: Combining curative and preventive interventions at 37.5 % annual coverage with degree-based allocation decreased prevalence and incidence of HCV infection by 67 % and 70 % over two years, respectively. Curative interventions decreased prevalence by six to 12 times more than preventive interventions, while curative and preventive interventions had comparable effectiveness on reducing incidence. Intervention impact increased with coverage almost linearly across all intervention strategies, and degree-based allocation was always more effective than random allocation, especially for preventive interventions. Results were sensitive to parameter values defining intervention effects and network mean degree.
Conclusion: DAA treatments are effective in reducing both prevalence and incidence of HCV infection in PWID, but preventive interventions play a significant role in reducing incidence when intervention coverage is low. Increasing coverage, including efforts in reaching individuals with the most injection partners, preventing reinfection, and improving compliance and retention in preventive services can substantially improve the outcomes. PWID network characteristics should be considered when designing hepatitis C elimination programs.
Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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