Potential impact of curative and preventive interventions toward hepatitis C elimination in people who inject drugs – a network modeling study

Details

• Alternative Title:
  Int J Drug Policy
• Personal Author:
  Zhu, Lin ; Thompson, William W. ; Hagan, Liesl ; Randall, Liisa M. ; Rudolph, Abby E. ; Young, April M. ; Havens, Jennifer R. ; Salomon, Joshua A. ; Linas, Benjamin P.
• Description:
  Background
  
  Injection-equipment-sharing networks play an important role in hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Direct-acting antiviral (DAA) treatments for HCV infection and interventions to prevent HCV transmission are critical components of an overall hepatitis C elimination strategy, but how they contribute to the elimination outcomes in different PWID network settings are unclear.
  
  Methods
  
  We developed an agent-based network model of HCV transmission through the sharing of injection equipment among PWID and parameterized and calibrated the model with rural PWID data in the United States. We modeled curative and preventive interventions at annual coverage levels of 12.5%, 25%, or 37.5% (cumulative % of eligible engaged), and two allocation approaches: random vs targeting PWID with more injection partners (hereafter ‘degree-based’). We compared the impact of these intervention strategies on prevalence and incidence of HCV infections. We conducted sensitivity analysis on key parameters governing the effects of curative and preventive interventions and PWID network characteristics.
  
  Results
  
  Combining curative and preventive interventions at 37.5% annual coverage with degree-based allocation decreased prevalence and incidence of HCV infection by 67% and 70% over two years, respectively. Curative interventions decreased prevalence by six to 12 times more than preventive interventions, while curative and preventive interventions had comparable effectiveness on reducing incidence. Intervention impact increased with coverage almost linearly across all intervention strategies, and degree-based allocation was always more effective than random allocation, especially for preventive interventions. Results were sensitive to parameter values defining intervention effects and network mean degree.
  
  Conclusion
  
  DAA treatments are effective in reducing both prevalence and incidence of HCV infection in PWID, but preventive interventions play a significant role in reducing incidence when intervention coverage is low. Increasing coverage, including efforts in reaching individuals with the most injection partners, preventing reinfection, and improving compliance and retention in preventive services can substantially improve the outcomes. PWID network characteristics should be considered when designing hepatitis C elimination programs.
  
  
• Subjects:
  Antiviral Agents Hepatitis C Humans Incidence Models, Theoretical Needle Sharing Prevalence Substance Abuse, Intravenous United States
• Keywords:
  Direct-acting Antiviral Treatment Harm Reduction Hepatitis C People Who Inject Drugs Simulation Model Social Network
• Source:
  Int J Drug Policy. 130:104539
• Pubmed ID:
  39033645
• Pubmed Central ID:
  PMC11347083
• Document Type:
  Journal Article
• Funding:
  K99 DA056297/DA/NIDA NIH HHSUnited States/ ; R01 DA033862/DA/NIDA NIH HHSUnited States/ ; R37 DA015612/DA/NIDA NIH HHSUnited States/ ; R01 DA024598/DA/NIDA NIH HHSUnited States/ ; U38 PS004644/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  130
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:4d924d88adcf77116dae6f887c4f5976c9181fa80c2d7b9278db443d69b487b0cba0d5bdbc6db39395d789f8516389e4c6877f29a52246a6aa7c6ea567706d1a
• Download URL:
  https://stacks.cdc.gov/view/cdc/160653/cdc_160653_DS1.pdf
• File Type:
  [PDF - 926.51 KB ]