Dynamic modelling of hepatitis C transmission among people who inject drugs: A tool to support WHO elimination targets

2018 ◽  
Author(s):  
Theresa Stocks ◽  
Leah J. Martin ◽  
Sharon Kühlmann-Berenzon ◽  
Tom Britton
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
High Income ◽  
Disease Stage ◽  
Data Set ◽  
True Incidence ◽  
Needle Exchange Programs ◽  
Shiny App ◽  
Hcv Transmission ◽  
The Impact

AbstractTo reach the WHO goal of hepatitis C elimination, it is essential to identify the number of people unaware of their hepatitis C virus (HCV) infection and to investigate the effect of interventions on the disease transmission dynamics. In many middle- and high-income countries, one of the primary routes of HCV transmission is via contaminated needles shared by people who inject drugs (PWIDs). However, substantial underreporting combined with high uncertainty regarding the size of this difficult to reach population, makes it challenging to estimate the core indicators recommended by the WHO. To help enable countries to monitor their progress towards the elimination goal, we present a novel multi-layered dynamic transmission model for HCV transmission within a PWID population. The model explicitly accounts for disease stage (acute and chronic), injection drug use status (active and former PWIDs), status of diagnosis (diagnosed and undiagnosed) and country of disease acquisition (domestic or abroad). First, based on this model, and using routine surveillance data, we estimate the number of undiagnosed PWIDs, the true incidence, the average time until diagnosis, the reproduction numbers and associated uncertainties. Second, we examine the impact of two interventions on disease dynamics: 1) direct-acting antiviral drug treatment, and 2) needle exchange programs. To make the model accessible to relevant users and to support communication of our results to public health decision makers, the model and its output are made available through a Shiny app. As a proof of concept, we illustrate our results for a specific data set; however, through the app our model can be easily adapted to other high-income countries with similar transmission patterns among PWIDs where the disease is endemic.

scholarly journals Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Addiction ◽  
2017 ◽  
Vol 112 (7) ◽  
pp. 1302-1314 ◽  
Author(s):  
Jack Stone ◽  
Natasha K. Martin ◽  
Matthew Hickman ◽  
Sharon J. Hutchinson ◽  
Esther Aspinall ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Hcv Treatment ◽  
Hcv Transmission ◽  
The Impact

scholarly journals Spatiotemporal Reconstruction of the Introduction of Hepatitis C Virus into Scotland and Its Subsequent Regional Transmission

2015 ◽  
Vol 89 (22) ◽  
pp. 11223-11232 ◽  
Author(s):  
Anna L. McNaughton ◽  
Iain Dugald Cameron ◽  
Elizabeth B. Wignall-Fleming ◽  
Roman Biek ◽  
John McLauchlan ◽  
...  
Keyword(s):  
Public Health ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hot Spots ◽  
People Who Inject Drugs ◽  
Transmission Dynamics ◽  
Data Set ◽  
Health Initiatives ◽  
Hcv Transmission ◽  
Public Health Initiatives

ABSTRACTA more comprehensive understanding of hepatitis C virus (HCV) transmission dynamics could facilitate public health initiatives to reduce the prevalence of HCV in people who inject drugs. We aimed to determine how HCV sequences entered and spread throughout Scotland and to identify transmission hot spots. A Scottish data set with embedded demographic data was created by sequencing the NS5B of 125 genotype 1a (Gt1a) samples and 166 Gt3a samples and analyzed alongside sequences from public databases. Applying Bayesian inference methods, we reconstructed the global origin and local spatiotemporal dissemination of HCV in Scotland. Scottish sequences mainly formed discrete clusters interspersed between sequences from the rest of the world; the most recent common ancestors of these clusters dated to 1942 to 1952 (Gt1a) and 1926 to 1942 (Gt3a), coincident with global diversification and distribution. Extant Scottish sequences originated in Edinburgh (Gt1a) and Glasgow (Gt3a) in the 1970s, but both genotypes spread from Glasgow to other regions. The dominant Gt1a strain differed between Edinburgh (cluster 2 [C2]), Glasgow (C3), and Aberdeen (C4), whereas significant Gt3a strain specificity occurred only in Aberdeen. Specific clusters initially formed separate transmission zones in Glasgow that subsequently overlapped, occasioning city-wide cocirculation. Transmission hot spots were detected with 45% of samples from patients residing in just 9 of Glasgow's 57 postcode districts. HCV was introduced into Scotland in the 1940s, concomitant with its worldwide dispersal likely arising from global-scale historical events. Cluster-specific transmission hubs were identified in Glasgow, the key Scottish city implicated in HCV dissemination. This fine-scale spatiotemporal reconstruction improves understanding of HCV transmission dynamics in Scotland.IMPORTANCEHCV is a major health burden and the leading cause of hepatocellular carcinoma. Public health needle exchange and “treatment as prevention” strategies targeting HCV are designed to reduce prevalence of the virus in people who inject drugs (PWID), potentially mitigating the future burden of HCV-associated liver disease. Understanding HCV transmission dynamics could increase the effectiveness of such public health initiatives by identifying and targeting regions playing a central role in virus dispersal. In this study, we examined HCV transmission in Scotland by analyzing the genetic relatedness of strains from PWID alongside data inferring the year individuals became infected and residential information at a geographically finer-scale resolution than in previous studies. Clusters of Scotland-specific strains were identified with regional specificity, and mapping the spread of HCV allowed the identification of key areas central to HCV transmission in Scotland. This research provides a basis for identifying HCV transmission hot spots.

scholarly journals Modelling the impact of a national scale-up of interventions on hepatitis C virus transmission among people who inject drugs in Scotland

Addiction ◽  
2018 ◽  
Vol 113 (11) ◽  
pp. 2118-2131 ◽  
Author(s):  
Hannah Fraser ◽  
Christinah Mukandavire ◽  
Natasha K. Martin ◽  
David Goldberg ◽  
Norah Palmateer ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Virus Transmission ◽  
National Scale ◽  
The Impact ◽  
Hepatitis C Virus Transmission

scholarly journals Hepatitis C and pregnancy outcomes: a systematic review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024288 ◽  
Author(s):  
Stephanie Parent ◽  
Kate Salters ◽  
Lindila Awendila ◽  
Lianping Ti
Keyword(s):  
Systematic Review ◽  
Hepatitis C ◽  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Cochrane Library ◽  
Childbearing Age ◽  
Hcv Treatment ◽  
Conference Abstract ◽  
Hcv Transmission ◽  
The Impact

IntroductionMany women living with hepatitis C (HCV) are of childbearing age. While the risk of vertical HCV transmission has been well established, the impact of HCV on pregnancy outcomes are equivocal, with some studies reporting risks of preterm birth, low gestational weight, gestational diabetes and hypertension, while other studies report no such risks. With the shift of the HCV treatment landscape to more effective, tolerable and shorter medications, understanding pregnancy outcomes of women living with HCV are an important consideration in order to provide a baseline from which to consider the usefulness and safety of HCV treatment for this population. The objective of this systematic review will be to investigate pregnancy outcomes associated with maternal HCV infection.Methods and analysisThis systematic review will incorporate articles relevant to pregnancy outcomes among women living with HCV (eg, gestational diabetes and caesarean delivery). Articles will be retrieved from academic databases including MEDLINE, EMBASE, CINAHL, clinicaltrial.gov and the Cochrane Library and hand searching of conference proceedings and reference lists. A database search will not be restricted by date, and conference abstract will be restricted to the past 2 years. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of the retrieved studies. Data will be extracted and scored independently by two authors. A narrative account will synthesise the findings to answer the objectives of this review.Ethics and disseminationThis systematic review will synthesise the literature on the pregnancy outcomes of women living with HCV. Results from this review will be disseminated to clinical audiences, community groups and policy-makers, and may support clinicians and decision-makers in developing guidelines to promote best outcomes for this population.

Incarceration of People who inject Drugs – Modelling its Role in HCV Transmission and the Impact of Scaled-Up HCV Treatment in Prisons

2016 ◽  
Vol 64 (2) ◽  
pp. S811
Author(s):  
J. Stone ◽  
N.K. Martin ◽  
M. Hickman ◽  
S. Hutchinson ◽  
E. Aspinall ◽  
...  
Keyword(s):  
People Who Inject Drugs ◽  
Hcv Treatment ◽  
Hcv Transmission ◽  
The Impact

scholarly journals 54 THE IMPACT OF INJECTING NETWORKS ON HEPATITIS C TRANSMISSION AND TREATMENT IN PEOPLE WHO INJECT DRUGS

2013 ◽  
Vol 58 ◽  
pp. S23-S24 ◽  
Author(s):  
M. Hellard ◽  
D. Rolls ◽  
R. Sacks Davis ◽  
G. Robins ◽  
P. Pattison ◽  
...  
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
The Impact

scholarly journals Evaluating the impact and cost-effectiveness of scaling-up HCV treatment among people who inject drugs in Ukraine

2021 ◽  
Author(s):  
Jack Stone ◽  
Josephine G Walker ◽  
Sandra Bivegete ◽  
Adam Trickey ◽  
Charles Chasela ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
People Who Inject Drugs ◽  
Cost Effective ◽  
Treatment Rate ◽  
Hcv Treatment ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Hcv Transmission ◽  
Preventative Interventions ◽  
The Impact

Introduction People who inject drugs (PWID) in Ukraine have a high prevalence of hepatitis C virus (HCV). Since 2015, PWID have been receiving HCV treatment, but their impact and cost-effectiveness has not been estimated. Methods We developed a dynamic model of HIV and HCV transmission among PWID in Ukraine, incorporating ongoing HCV treatment (5,933 treatments) over 2015-2021; 46.1% among current PWID. We estimated the impact of these treatments and different treatment scenarios over 2021-2030: continuing recent treatment rates (2,394 PWID/year) with 42.5/100% among current PWID, or treating 5,000/10,000 current PWID/year. We also estimated the treatment rate required to decrease HCV incidence by 80% if preventative interventions are scaled-up or not. Required costs were collated from previous studies in Ukraine. We estimated the incremental cost-effectiveness ratio (ICER) of the HCV treatments undertaken in 2020 (1,059) by projecting the incremental costs and disability adjusted life years (DALYs) averted over 2020-2070 (3% discount rate) compared to a counterfactual scenario without treatment from 2020 onwards. Results On average, 0.4% of infections among PWID were treated annually over 2015-2021, without which HCV incidence would have been 0.6% (95%CrI: 0.3-1.0%) higher in 2021. Continuing existing treatment rates could reduce HCV incidence by 10.2% (7.8-12.5%) or 16.4% (12.1-22.0%) by 2030 if 42.5% or 100% of treatments are given to current PWID, respectively. HCV incidence could reduce by 29.3% (20.7-44.7%) or 93.9% (54.3-99.9%) by 2030 if 5,000 or 10,000 PWID are treated annually. To reduce incidence by 80% by 2030, 19,275 (15,134-23,522) annual treatments are needed among current PWID, or 17,955 (14,052-21,954) if preventative interventions are scaled-up. The mean ICER was US$828.8/DALY averted; cost-effective at a willingness-to-pay threshold of US$3,096/DALY averted (1xGDP). Implications Existing HCV treatment is cost-effective but has had little preventative impact due to few current PWID being treated. Further treatment expansion for current PWID could significantly reduce HCV incidence.

scholarly journals A comparison of two biological markers of recent hepatitis C virus (HCV) infection: implications for the monitoring of interventions and strategies to reduce HCV transmission among people who inject drugs

2018 ◽  
Vol 23 (47) ◽  
Author(s):  
Vivian D Hope ◽  
Ross J Harris ◽  
Peter Vickerman ◽  
Lucy Platt ◽  
Justin Shute ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Biological Markers ◽  
People Who Inject Drugs ◽  
Credible Interval ◽  
Accurate Estimate ◽  
Hcv Rna ◽  
Recent Infection ◽  
Cross Sectional ◽  
Hcv Transmission

Background Monitoring hepatitis C virus (HCV) incidence is important for assessing intervention impact. Longitudinal studies of people who inject drugs (PWID), using repeated biological tests, are costly; alternatively, incidence can be estimated using biological markers of recent infection in cross-sectional studies. Aim We aimed to compare incidence estimates obtained from two different biological markers of recent infection in a cross-sectional study to inform monitoring approaches for HCV elimination strategies. Method Samples from an unlinked anonymous bio-behavioural survey of PWID were tested for two recent infection markers: HCV RNA with anti-HCV negative (‘RNA’) and low-avidity anti-HCV with HCV RNA present (‘avidity’). These two markers were used separately and in combination to estimate HCV incidence. Results Between 2011 and 2013, 2,816 anti-HIV-negative PWID (25% female) who had injected during the preceding year were either HCV-negative or had one of the two markers of recent infection: 57 (2.0%) had the RNA marker and 90 (3.2%) the avidity marker. The two markers had similar distributions of risk and demographic factors. Pooled estimated incidence was 12.3 per 100 person-years (pyrs) (95% credible interval: 8.8–17.0) and not significantly different to avidity-only (p = 0.865) and RNA-only (p = 0.691) estimates. However, the RNA marker is limited by its short duration before anti-HCV seroconversion and the avidity marker by uncertainty around its duration. Conclusion Both markers have utility in monitoring HCV incidence among PWID. When HCV transmission is high, one marker may provide an accurate estimate of incidence; when it is low or decreasing, a combination may be required.

scholarly journals Antiviral Treatment to Prevent Transmission of Hepatitis C in People Who Inject Drugs

2016 ◽  
Vol 3 (1) ◽  
pp. 130-137
Author(s):  
Eric Dieperink ◽  
Astrid Knott
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Antiviral Treatment ◽  
Current Evidence ◽  
Treatment As Prevention ◽  
Exchange Programs ◽  
Needle Exchange Programs ◽  
Immunodeficiency Virus ◽  
Direct Acting ◽  
Review Current

The hepatitis C virus (HCV) is common among people who inject drugs (PWID) and causes significant morbidity and mortality. Opiate replacement therapy and needle exchange programs have effectively prevented the transmission of the Human immunodeficiency virus (HIV) but have been less effective for HCV. Other HCV prevention strategies are needed. Antiviral therapy with all oral direct acting antivirals is currently available and appears to be highly effective even in PWID and offers a possible strategy to further prevention efforts. This paper will review current evidence for treatment as prevention for HCV in PWID.

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