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Modelling the potential prevention benefits of a treat-all hepatitis C treatment strategy at global, regional, and country levels: a modelling study

Research output: Contribution to journalArticle

Original languageEnglish
JournalJournal of Viral Hepatitis
DateAccepted/In press - 15 Jul 2019

Abstract

Background: The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional, and global-levels. We assessed what country-level factors affect impact.

Methods: A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN datasets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20-years. Linear regression identified associations between IA per treatment and demographic factors.

Results: Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20-years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35, and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country’s population growth-rate, and negatively associated with higher HCV prevalence among PWID.

Conclusions: Appreciable prevention benefits could be achieved from WHO’s treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth.

    Research areas

  • DAA, treat, averted, infections, HCV

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