title: Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting?
abstract: OBJECTIVE
  To project the impact of scaling-up oral anti-viral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programmes to achieve specific targets and to examine whether hepatitis C virus (HCV) elimination among PWID is possible in this high-prevalence setting.
  
  
  METHODS
  A dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for re-infection following treatment.
  
  
  METHODS
  The population of 8300 PWID in Athens Metropolitan area.
  
  
  METHODS
  Reduction in HCV prevalence and incidence in 2030 compared with 2016.
  
  
  RESULTS
  Moderate expansion of HCV treatment (treating 4-8% of PWID/year), with a simultaneous increase of 2%/year in harm reduction coverage (from 44 to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46.2-94.8% in 2030, compared with 2016. CHC prevalence would reduce to below 10% within the next 4-5 years if annual HCV treatment numbers were increased up to 16-20% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates.
  
  
  CONCLUSIONS
  Based on theoretical model projections, scaled-up hepatitis C virus treatment and harm reduction interventions could achieve major reductions in hepatitis C virus incidence and prevalence among people who inject drugs in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4-5 years by increasing treatment to more than 16% of people who inject drugs per year combined with moderate increases in harm reduction coverage.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Gountas
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: Vana
authors.initials: V
authors.lastname: Sypsa
authors.affiliation: Organization Against Drugs (OKANA), Athens, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Anagnostou
authors.affiliation: Division of Global Public Health, University of California, San Diego, CA, USA.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Martin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.affiliation: Organization Against Drugs (OKANA), Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kafetzopoulos
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: Angelos
authors.initials: A
authors.lastname: Hatzakis
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D015897:Comorbidity; D006115:Greece / Q000453:epidemiology; D040261:Harm Reduction; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008962:Models, Theoretical; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*
chemical_list: D000998:Antiviral Agents
keywords: Antiviral therapy; Greece; dynamic modeling; elimination; harm reduction; hepatitis C; treatment as prevention