Scaling Up HCV Treatment, Syringe Services and Medicated-Assisted Treatment for Achieving Rapid HCV Elimination in Rural America – Model Projections For Indiana

Author: Fraser H, Zibbell JE, Hoerger T, Hariri S, Vellozzi C, Martin NK, Kral A, Hickman M, Ward JW, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2016


Fraser H1, Zibbell JE2, Hoerger T3, Hariri S2, Vellozzi C2, Martin NK4,1, Kral A3, Hickman M1, Ward JW2, Vickerman P1

1. Social and Community Medicine, University of Bristol, UK

2. U.S. Centers for Disease Control and Prevention, Atlanta, USA

3. RTI International, Research Triangle Park, USA

4. University of California, San Diego, California, USA

Background: Recent increases in the number of people who inject drugs (PWID) and number of acute HCV infections in non-urban localities in the United States have generally remained unchecked, with little prevention services and negligible HCV treatment for PWID. We estimate levels of medicated assisted treatment (MAT), syringe service programs (SSPs) and HCV treatment needed to reduce HCV prevalence and incidence among PWID to low levels in Indiana.

Methods: We developed a HCV transmission model among PWID that we calibrated to epidemiological data from rural Indiana. We assumed no baseline interventions, that an increase in HCV transmission occurred from 2011-2014 based on observed increases in the incidence of acute HCV infections, and a population size of 436-600 PWID. We project the impact on chronic prevalence and incidence of scaling-up SSP to 50% coverage, MAT to 25%/50% coverage, mass-treating 20%/40%/60% of existing chronic infections over 1/2/4 years, and the treatment number needed to reduce chronic prevalence to <1% in 5/10 years. Results: Scaling-up SSP+MAT decreased HCV incidence by 42% over 5-years, but was insufficient to decrease prevalence due to the increasing baseline epidemic. Short periods of mass-treatment (60% of existing chronic infections (138 PWID) treated over 2-years) with 50% SSP+MAT coverage decreased chronic HCV prevalence (37% by 5-years), but impact diminished once treatment halted (26% decrease by 10-years). Continued low levels of treatment (4 PWID treated annually) alongside 50% SSP+MAT maintained the impact achieved. Chronic prevalence can be reduced to <1% in 10-years if 44 PWID are treated annually with 50% SSP+MAT coverage. Conclusion: Analyses suggest scaling-up HCV treatment alongside SSP+MAT can dramatically decrease HCV infection in rural Indiana. Such settings could act as model sites to illustrate how concurrent scale-up of prevention and treatment services could reduce HCV prevalence and incidence to near elimination levels in a short time-frame. Disclosure of Interest Statement: This study was supported by Contract No. 200-2013-M-53964B GS-10F-0097L from the Centers for Disease Control and Prevention (CDC) to RTI International and a subcontract from RTI International to the University of Bristol. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the CDC, RTI International, or the University of Bristol.

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