HCV elimination among people who inject drugs. Modelling pre- and post-WHO elimination era
HCV elimination among people who inject drugs. Modelling pre- and post-WHO elimination era
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DOI：
10.1371/journal.pone.0202109
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发表时间：
2018-08-16
期刊：
影响因子：
3.7
通讯作者：
Hatzakis, Angelos
中科院分区：
文献类型：
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作者：
Gountas, Ilias;Sypsa, Vana;Hatzakis, Angelos
背景在注射吸毒者中消除丙型肝炎病毒（HCV）是一项昂贵的投资，因此策略不仅要关注消除疾病，还要关注预防疾病复发。这项研究的目的是计算最低必要的抗病毒治疗，以实现消除与不额外扩大的损害减少（HR）计划，并检查丙型肝炎病毒消除的可持续性后，2030年，如果治疗停止。在三个基线慢性HCV（CHC）患病率环境中（参与共享设备（共享者）的PWID比例较低（30%）和较高（50%））（30%、45%和60%），假设基线人力资源覆盖率为40%。我们定义可持续的消除策略，那些可以保持消除结果十年（2031-2040），在没有额外的treatment.ResultsThe模型表明，最佳消除策略是依赖于风险分担行为的检查人口。在基线CHC患病率低于45%的情况下实现HCV消除所需的年度治疗覆盖率在4.7- 5.1%之间，而不同时扩大人力资源计划。同样，在基线CHC患病率为60%的情况下，所需治疗覆盖率为9.0- 10.5%。将HR覆盖率从40%提高到75%，在CHC患病率为45%或60%的情况下，所需治疗覆盖率分别降低6.5-9.8%和11.0-15.0%。在设置中，
BackgroundElimination of hepatitis C virus (HCV) among people who inject drugs (PWID) is a costly investment, so strategies should not only focus on eliminating the disease, but also on preventing disease resurgence. The aims of this study are to compute the minimum necessary antiviral therapies to achieve elimination with and without the additional expansion of harm reduction (HR) programs and to examine the sustainability of HCV elimination after 2030 if treatment is discontinued.MethodWe considered two types of epidemic (with low (30%) and high (50%) proportion of PWID who engage in sharing equipment (sharers)) within three baseline chronic HCV (CHC) prevalence settings (30%, 45% and 60%), assuming a baseline HR coverage of 40%. We define sustainable elimination strategies, those that could maintain eliminations results for a decade (2031-2040), in the absence of additional treatment.ResultsThe model shows that the optimum elimination strategy is dependent on risk sharing behavior of the examined population. The necessary annual treatment coverage to achieve HCV elimination under 45% baseline CHC prevalence, without the simultaneous expansion of HR programs, ranges between 4.7-5.1%. Similarly, under 60% baseline CHC prevalence the needed treatment coverage varies from 9.0-10.5%. Increasing HR coverage from 40% to 75%, reduces the required treatment coverage by 6.5-9.8% and 11.0-15.0% under 45% or 60% CHC prevalence, respectively. In settings with