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.