Treatment-as-prevention only viable with expanded HCV coverage

published on August 30, 2018 by Zelenev A, et al. Lancet. 2018;doi:10.1016/S1473-3099(17)30676-X., in Healio

Results of a modeling study showed that in dense urban settings with high prevalence of hepatitis C among people who inject drugs, HCV treatment-as-prevention strategies will have little impact over 10 years unless coverage is greatly expanded.

“With the availability of more tolerable and eective direct-acting antivirals, HCV treatment-as-prevention strategies could substantially curtail HCV transmission and reduce the burden of HCV,” Alexei Zelenev, PhD, from the Yale School of Medicine in Connecticut, and colleagues wrote. “Completely eliminating HCV ... will require a strategic combination of prevention (eg, harm reduction) and treatment-as-prevention strategies, including the expansion of HCV treatment into dierent clinical care settings.”

The study design included a network model that evolved from an empirically-based risk network of PWIDs and a transmission model that captured the process of HCV and HIV transmission among individuals who shared injection equipment.

The model showed that at the highest HCV prevalence among PWIDs (85%), expanded treatment coverage will not substantially reduce HCV prevalence over 10 years or 20 years for any of the following treatment-as-prevention strategies: random patient selection regardless of available primary contacts, chain treatment from random patient to referrals, or targeting highest number of injection partners regardless of available primary contacts.

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Treatment-as-prevention only viable with expanded HCV coverage

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