title: Treatment of hepatitis C as prevention: a modeling case study in Vietnam.
abstract: BACKGROUND
  Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50-90% of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored.
  
  
  RESULTS
  In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75% of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50% coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values.
  
  
  CONCLUSIONS
  In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission and prevalence.
authors.affiliation: Independent Research, Bangkok, Thailand. nicolasdurier@hotmail.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.forename: Chi
authors.initials: C
authors.lastname: Nguyen
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: White
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D055030:Drug Users; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008962:Models, Theoretical; D010349:Patient Compliance; D015995:Prevalence; D013997:Time Factors; D014744:Vietnam
chemical_list: D000998:Antiviral Agents