Modelling antiviral treatment to prevent hepatitis C infection among people who inject drugs in Victoria, Australia.
OBJECTIVE
To develop a mathematical model to project the potential impact of hepatitis C virus (HCV) treatment on HCV infection prevalence among people who inject drugs (PWID).


METHODS
An existing model of HCV transmission among PWID was parameterised using data from Victoria, Australia, including specific parameter estimates of the number of people who are currently active injecting drug users, average duration of injecting, chronic HCV infection prevalence among PWID, annual mortality, and annual HCV treatment rate. We also explored the impact of prevalence uncertainty, program scale-up, and new treatments.


METHODS
Prevalence of chronic HCV infection among people who are currently active injecting drug users.


RESULTS
With annual treatment rates of 13, 17, or 25 per 1000 PWID, the model predicts relative prevalence reductions of 20%, 30%, and 50%, respectively, within 30 years. If new treatments giving higher sustained viral response rates are available in 5 years, estimated impact is increased by 21%–23% at 15 years, and 17%–38% at 30 years, depending on treatment rates.


CONCLUSIONS
This model suggests that modest rates of current HCV treatment among PWID in Victoria, Australia could halve HCV infection prevalence among PWID in 30 years. This finding suggests that interventions aimed at increasing access to HCV treatment in community clinics will benefit individual PWID and reduce HCV infection prevalence.
Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia. hellard@burnet.edu.au
Margaret E
ME
Hellard
Rebecca
R
Jenkinson
Peter
P
Higgs
Mark A
MA
Stoové
Rachel
R
Sacks-Davis
Judy
J
Gold
Matthew
M
Hickman
Peter
P
Vickerman
Natasha K
NK
Martin
D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D055030:Drug Users; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008954:Models, Biological; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D015995:Prevalence; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014739:Victoria / Q000453:epidemiology
D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a