RESEARCH TRIANGLE PARK, N.C. AND UNIVERSITY OF BRISTOL, UK — A new study models the impact of increased treatment of hepatitis C virus (HCV) infection among people who inject drugs. The study finds that an increase of clean injecting equipment provided through syringe service programs, provision of medication assisted treatment (MAT), and antiviral treatment for hepatitis C among people who inject drugs could reduce incidence of HCV in the United States by 90 percent by 2030.
“Our modelling shows that modest scale-up of HCV treatment, combined with syringe service program and medication assisted treatment, can reverse the HCV burden in the United States and potentially achieve elimination goals in the next 10 to 15 years,” said Hannah Fraser, PhD, Senior Research Associate in Infectious Disease Mathematical Modelling at the University of Bristol, and lead author of the study.
The research conducted at Bristol Medical School, University of Bristol and RTI International, a non-profit research institute, and funded by the U.S. Centers for Disease Control and Prevention, lines up with a target for HCV elimination set by the U.S. National Academies of Sciences, Engineering and Medicine (NASEM). The study uses mathematical models to estimate the impact of scaling up harm reduction services and HCV treatment in San Francisco, California, and Perry County, Kentucky.
“We are facing an expanding epidemic of HCV among people who inject drugs due to the on-going opioid epidemic. Our research suggests that elimination goals can be achieved in both large cities and rural areas in the United States,” said Thomas Hoerger, PhD, senior fellow at RTI International, and one of the study authors.
San Francisco has an established community of people who inject drugs and a fairly constant HCV prevalence. In contrast, rural Perry County has an increasing HCV epidemic alongside a young and expanding population of people who inject drugs. Using data from San Francisco and Perry County, the researchers developed mathematical models to estimate the number of people who inject drugs who would need to be treated to reduce HCV incidence by 90 percent by 2030, both in combination and without increasing harm reduction services. In San Francisco, there is currently high coverage of syringe service programs with moderate medication assisted treatment, while at the time of modelling, no syringe service programs existed in Perry County, with minimal medication assisted treatment.
Assuming increases in syringe service programs (in Perry County) and increases in medication assisted treatment (both places), to achieve the elimination target in San Francisco 1,418 people who inject drugs initially need to be treated each year with a total of 19,019 needing treatment between 2017-2030. Due to the smaller population size in Perry County, only 22 people who inject drugs initially need treatment each year to achieve the target – totalling 288 treatments between 2017-2030.
The researchers found that not increasing the provision of harm reduction services more than doubled the number of treatments needed for elimination in Perry County, whereas it had little effect in San Francisco because existing provision of harm reduction services is much higher.
“Field studies are now needed to demonstrate the feasibility and impact of such strategies. This will help to inform harm reduction policy, and therefore, potentially enable the United States to reduce HCV as a public health threat,” said Peter Vickerman, DPhil, professor of Infectious Disease Modeling at the University of Bristol, who supervised the study.
Hepatitis C is a blood-borne infection that can seriously damage the liver and cause death if left untreated. Around 3.5 million people are infected with HCV in the US and the majority of new infections are acquired through injecting drugs, according to the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Reported cases of acute HCV infections have tripled since 2010, coinciding with increases in injection of opiates and other drugs. Harm reduction services include syringe service programmes which provide sterile injecting equipment, and medication assisted treatment, usually with methadone, which aims to reduce the use and injection of illicit drugs. However, the availability of these services varies widely across the US. Recent advances in HCV treatment with direct-acting antiviral medications can reduce HCV to undetectable levels in most patients.