title: The Impact of Enhanced Screening and Treatment on Hepatitis C in the United States.
abstract: BACKGROUND
  The effectiveness of interferon-free direct-acting antivirals (DAA) in treating chronic hepatitis C virus (HCV) is limited by low screening and treatment rates, particularly among people who inject drugs (PWIDs).
  
  
  METHODS
  To evaluate the levels of screening and treatment with interferon-free DAAs that are required to control HCV incidence and HCV-associated morbidity and mortality, we developed a transmission model, stratified by age and by injection drug use, and calibrated it to epidemiological data in the United States from 1992 to 2014. We quantified the impact of administration of DAAs at current and at enhanced screening and treatment rates, focusing on outcomes of HCV incidence, prevalence, compensated and decompensated cirrhosis, hepatocellular carcinoma, liver transplants, and mortality from 2015 to 2040.
  
  
  RESULTS
  Increasing annual treatment of patients 4-fold-from the approximately 100 000 treated historically to 400 000-is predicted to prevent 526 084 (95% confidence interval, 466 615-593 347) cases of cirrhosis and 256 315 (201 589-316 114) HCV-associated deaths. By simultaneously increasing treatment capacity and increasing the number of HCV infections diagnosed, total HCV prevalence could fall to as low as 305 599 (222 955-422 110) infections by 2040. Complete elimination of HCV transmission in the United States through treatment with DAAs would require nearly universal screening of PWIDs, with an annual treatment rate of at least 30%.
  
  
  CONCLUSIONS
  Interferon-free DAAs are projected to achieve marked reductions in HCV-associated morbidity and mortality. Aggressive expansion in HCV screening and treatment, particularly among PWIDs, would be required to eliminate HCV in the United States.
authors.affiliation: Center for Infectious Disease Modeling and Analysis.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health.
authors.forename: David P
authors.initials: DP
authors.lastname: Durham
authors.affiliation: Center for Infectious Disease Modeling and Analysis.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Skrip
authors.affiliation: Department of Medicine, Cornell Scott-Hill Health Center.|Department of Medicine.
authors.forename: Robert Douglas
authors.initials: RD
authors.lastname: Bruce
authors.affiliation: Departments of Genetics and Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vilarinho
authors.affiliation: Merck & Co., Inc., Kenilworth, New Jersey.
authors.forename: Elamin H
authors.initials: EH
authors.lastname: Elbasha
authors.affiliation: Center for Infectious Disease Modeling and Analysis.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health.|Program in Computational Biology and Bioinformatics, Yale University.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
authors.affiliation: Program in Computational Biology and Bioinformatics, Yale University.|Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Townsend
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000453:epidemiology / Q000517:prevention & control; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: direct-acting antivirals; hepatitis C; people who inject drugs; screening; treatment