Modelling Hepatitis C Virus Elimination And Monitoring Policies In Iceland

Author: Scott N, Olafsson S, Gottfredsson M, Tyrfingsson T, Sigmundsdottir G, Runarsdottir V, Hansdottir I, Hernandez UB, Hellard M

Theme: Epidemiology & Public Health Research Year: 2017

Background: In Iceland a nationwide program has been launched offering treatment for the entire population living with hepatitis C virus (HCV). We estimate (1) the time and treatment scale-up required to achieve the World Health Organization’s HCV elimination target of an 80% reduction in incidence; and (2) the ongoing frequency of HCV testing and harm reduction coverage among people who inject drugs (PWID) required to minimize the likelihood of future HCV outbreaks occurring.

Methods: We used a dynamic compartmental model of HCV transmission, liver disease progression and the HCV cascade of care.

Results: The model estimated that an 80% reduction in domestic HCV incidence was achievable by 2030, 2025 or 2020 if a minimum of 60/1000, 78/1000 and 208/1000 PWID were treated per year respectively (a total of 24, 31 or 83 PWID per year respectively). Regardless of time frame, this required an increased number of PWID to be diagnosed to generate enough treatment demand, or a 20% scale-up of harm reduction services to complement treatment-as-prevention incidence reductions. Combining a policy of annual antibody testing of PWID with DAA access was estimated to achieve the incidence reduction target by 2025. Providing DAA access with no other changes to current testing and harm reduction services reduced the basic reproduction number of HCV in Iceland from 1.08 to 0.56, indicating that future outbreaks would be unlikely.

Conclusion: HCV elimination in Iceland is achievable with some additional screening of PWID. Maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that future outbreaks are unlikely to occur once elimination targets have been reached.

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