Scaling-up HCV prevention and treatment interventions in rural United Statesmodel projections for tackling an increasing epidemic
Scaling-up HCV prevention and treatment interventions in rural United Statesmodel projections for tackling an increasing epidemic
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DOI：
10.1111/add.13948
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发表时间：
2018-01-01
期刊：
影响因子：
6
通讯作者：
Vickerman, Peter
中科院分区：
文献类型：
--
作者：
Fraser, Hannah;Zibbell, Jon;Vickerman, Peter
背景和目的需要有效的策略来解决美国农村地区注射毒品(PWID)者丙型肝炎病毒(HCV)感染的急剧增加问题。我们确定了在有或没有扩大丙型肝炎病毒预防干预措施的情况下，在美国农村地区实现到2025年和2030年将丙型肝炎病毒慢性流行率或发病率降低90%所需的扩大丙型肝炎病毒治疗的规模。设计了一个丙型肝炎病毒传播的常微分方程式模型，该模型校准了主要来自印第安纳州艾滋病毒爆发调查的丙型肝炎病毒流行病学数据。背景美国印第安纳州斯科特县(人口24181)，一个基线干预措施可以忽略的农村地区，自2010年以来丙型肝炎疫情不断增加，2015年在PWID中的慢性丙型肝炎感染率为55.3%。参与者PWID。衡量每1000 PWID所需的年度丙型肝炎治疗(以及最初的年度感染百分比)，以实现到2025/30年将丙型肝炎慢性流行率或发病率降低90%，无论是否扩大注射器服务计划(SSP)和药物辅助治疗(MAT)到50%的覆盖率。敏感性分析考虑了是否可以在不重新治疗再次感染的情况下实现这种影响，以及由于这种环境中的流行病日益增加，是否需要更大的干预规模。发现要在2030年实现发病率和流行率降低90%，而不扩大MAT和SSP规模，每1000名PWID中有159人(最初占受感染PWID的24.9%)需要每年接受丙型肝炎病毒治疗。然而，随着MAT和SSP规模的扩大，治疗率减半(每年每1000人或14.5%)。为了在2025年达到同样的目标，扩大MAT和SSP，每1000名PWID中有121人(19.9%)需要每年接受治疗。这些治疗要求比疫情稳定时高出三倍，如果不撤退，影响目标是无法实现的。结论需要扩大丙型肝炎病毒治疗和预防干预的组合规模，以在2025/30年前将美国印第安纳州农村地区日益增加的丙型肝炎病毒发病率和流行率负担降低90%。
Background and aimsEffective 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.DesignAn ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana.SettingScott County, Indiana (population 24181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015.ParticipantsPWID.MeasurementsRequired 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.FindingsTo 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.ConclusionsCombined 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.