Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis

Artenie, Andreea Adelina; Stone, Jack; Fraser, Hannah; Stewart, Daniel; Arum, Chiedozie; Lim, Aaron G; McNaughton, Anna L; Trickey, Adam; Ward, Zoe; Abramovitz, Daniela; Alary, Michel; Astemborski, Jacquie; Bruneau, Julie; Clipman, Steven J.; Coffin, Carla S.; Croxford, Sara; DeBeck, Kora; Emanuel, Eva; Hayashi, Kanna; Hermez, Joumana; Low‐Beer, Daniel; Luhmann, Niklas; Macphail, Gisela; Maher, Lisa; Palmateer, Norah; Patel, Eshan U.; Sacks‐Davis, Rachel; Boom, Wijnand van den; Santen, Daniëla K van; Walker, Josephine G.; Hickman, Matthew; Vickerman, Peter; Aladashvili, Malvina; Azim, Tasnim; Dietze, Paul; Dumchev, Kostyantyn; Havens, Jennifer R.; Hellard, Margaret; Hutchinson, Sharon; Iversen, Jennifer; Judd, Ali; Kåberg, Martin; Kurth, Ann; Mehta, Shruti H.; Mravčík, Viktor; Prins, Maria; Solomon, Sunil S.; Strathdee, Steffanie A.; Sypsa, Vana; Todd, Catherine S.; Valencia, Jorge; Wisse, Ernst

doi:10.1016/s2468-1253(23)00018-3

Cited by 34 publications

(15 citation statements)

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“…Stigma and shunning frequently encountered in conventional medical settings result in restricted health care access, including for hepatitis C virus (HCV) infection . Pooled HCV incidence is 12.1 per 100 person-years among people who inject drugs, and restricted access to direct-acting antivirals (DAAs) is a leading public health issue. Because of highly efficacious DAAs, many jurisdictions seek HCV elimination by 2030, which requires improving DAA access by people with opioid use disorder .…”

Section: Introductionmentioning

confidence: 99%

Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

Talal,

Markatou,

Liu

et al. 2024

JAMA

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ImportanceFacilitated telemedicine may promote hepatitis C virus elimination by mitigating geographic and temporal barriers.ObjectiveTo compare sustained virologic responses for hepatitis C virus among persons with opioid use disorder treated through facilitated telemedicine integrated into opioid treatment programs compared with off-site hepatitis specialist referral.Design, Setting, and ParticipantsProspective, cluster randomized clinical trial using a stepped wedge design. Twelve programs throughout New York State included hepatitis C–infected participants (n = 602) enrolled between March 1, 2017, and February 29, 2020. Data were analyzed from December 1, 2022, through September 1, 2023.InterventionHepatitis C treatment with direct-acting antivirals through comanagement with a hepatitis specialist either through facilitated telemedicine integrated into opioid treatment programs (n = 290) or standard-of-care off-site referral (n = 312).Main Outcomes and MeasuresThe primary outcome was hepatitis C virus cure. Twelve programs began with off-site referral, and every 9 months, 4 randomly selected sites transitioned to facilitated telemedicine during 3 steps without participant crossover. Participants completed 2-year follow-up for reinfection assessment. Inclusion criteria required 6-month enrollment in opioid treatment and insurance coverage of hepatitis C medications. Generalized linear mixed-effects models were used to test for the intervention effect, adjusted for time, clustering, and effect modification in individual-based intention-to-treat analysis.ResultsAmong 602 participants, 369 were male (61.3%); 296 (49.2%) were American Indian or Alaska Native, Asian, Black or African American, multiracial, or other (ie, no race category was selected, with race data collected according to the 5 standard National Institutes of Health categories); and 306 (50.8%) were White. The mean (SD) age of the enrolled participants in the telemedicine group was 47.1 (13.1) years; that of the referral group was 48.9 (12.8) years. In telemedicine, 268 of 290 participants (92.4%) initiated treatment compared with 126 of 312 participants (40.4%) in referral. Intention-to-treat cure percentages were 90.3% (262 of 290) in telemedicine and 39.4% (123 of 312) in referral, with an estimated logarithmic odds ratio of the study group effect of 2.9 (95% CI, 2.0-3.5; P &lt; .001) with no effect modification. Observed cure percentages were 246 of 290 participants (84.8%) in telemedicine vs 106 of 312 participants (34.0%) in referral. Subgroup effects were not significant, including fibrosis stage, urban or rural participant residence location, or mental health (anxiety or depression) comorbid conditions. Illicit drug use decreased significantly (referral: 95% CI, 1.2-4.8; P = .001; telemedicine: 95% CI, 0.3-1.0; P &lt; .001) among cured participants. Minimal reinfections (n = 13) occurred, with hepatitis C virus reinfection incidence of 2.5 per 100 person-years. Participants in both groups rated health care delivery satisfaction as high or very high.Conclusions and RelevanceOpioid treatment program–integrated facilitated telemedicine resulted in significantly higher hepatitis C virus cure rates compared with off-site referral, with high participant satisfaction. Illicit drug use declined significantly among cured participants with minimal reinfections.Trial RegistrationClinicalTrials.gov Identifier: NCT02933970

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Section: Introductionmentioning

confidence: 99%

Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

Talal,

Markatou,

Liu

et al. 2024

JAMA

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“…Both are consistent with our results;For FSWs and their partners in MENA, a 12-country modeling study estimated that FSW, their clients, and spouses of clients comprised 28% of adult infections in 2020, 34 similar to our 23% and 19% for SW, FSW clients, and partners of FSW clients in 2010 and 2022, respectively;Unlike for SW and MSM in SSA, for whom our infection estimates were supported by empirical meta-analyses, 3,31 for PWID, data about incidence and its trends are scarce. A meta-analysis of data published in 2000–2022 found a 1.7 per 100 person-years global incidence, 35 more than our 1.3 per 100 and 0.85 per 100 for 2010 and 2022, with most of this difference from MENA region. The review, based on limited temporal data, found no evidence of a shift over time.…”

Section: Discussionmentioning

confidence: 68%

“…Unlike for SW and MSM in SSA, for whom our infection estimates were supported by empirical meta-analyses, 3,31 for PWID, data about incidence and its trends are scarce. A meta-analysis of data published in 2000–2022 found a 1.7 per 100 person-years global incidence, 35 more than our 1.3 per 100 and 0.85 per 100 for 2010 and 2022, with most of this difference from MENA region. The review, based on limited temporal data, found no evidence of a shift over time.…”

Section: Discussionmentioning

confidence: 68%

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New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation

Korenromp,

Sabin,

Stover

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Previously, The Joint United Nations Programme on HIV/AIDS estimated proportions of adult new HIV infections among key populations (KPs) in the last calendar year, globally and in 8 regions. We refined and updated these, for 2010 and 2022, using country-level trend models informed by national data. Methods: Infections among 15–49 year olds were estimated for sex workers (SWs), male clients of female SW, men who have sex with men (MSM), people who inject drugs (PWID), transgender women (TGW), and non-KP sex partners of these groups. Transmission models used were Goals (71 countries), AIDS Epidemic Model (13 Asian countries), Optima (9 European and Central Asian countries), and Thembisa (South Africa). Statistical Estimation and Projection Package fits were used for 15 countries. For 40 countries, new infections in 1 or more KPs were approximated from first-time diagnoses by the mode of transmission. Infection proportions among nonclient partners came from Goals, Optima, AIDS Epidemic Model, and Thembisa. For remaining countries and groups not represented in models, median proportions by KP were extrapolated from countries modeled within the same region. Results: Across 172 countries, estimated proportions of new adult infections in 2010 and 2022 were both 7.7% for SW, 11% and 20% for MSM, 0.72% and 1.1% for TGW, 6.8% and 8.0% for PWID, 12% and 10% for clients, and 5.3% and 8.2% for nonclient partners. In sub-Saharan Africa, proportions of new HIV infections decreased among SW, clients, and non-KP partners but increased for PWID; elsewhere these groups' 2010-to-2022 differences were opposite. For MSM and TGW, the proportions increased across all regions. Conclusions: KPs continue to have disproportionately high HIV incidence.

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“…The 1.8% adult prevalence found in the 2021 serosurvey is much higher than 0.7% estimated globally for 2020 [24]. For PWID, recent studies support the model's estimated HCV incidence being lower than the global average, which a systematic review recently estimated to be 12.1 per 100 person-years [25]. For example, one pilot study conducted in 2015-2017 found incidence of reinfection after treatment to be 1.2 per 100 person-years and 8.3 per 100 person-years in a control group of individuals seeking harm reduction services [26].…”

Section: Discussionmentioning

confidence: 99%

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

et al. 2023

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Background Between May 2015 and February 2022, 77,168 hepatitis C virus (HCV)-infected people in Georgia have been treated through an HCV elimination programme. To project the programme’s long-term impacts, an HCV infection model was initially developed, based on data from surveys among people who inject drugs and a national serosurvey in 2015. Aim Accounting for follow-up surveys in 2021, we validate and update projections of HCV infection prevalence and incidence. Method We assessed the initial model projections’ accuracy for overall prevalence, by age, sex, and among people who ever injected drugs, compared with 2021 serosurvey data. We used 2021 results to weight model fits and to recalculate the national programme’s impact leading up to March 2022 on HCV infection incidence rates. Cases and deaths averted were estimated. The impact of reduced treatment rates during the COVID-19 pandemic was assessed. Results The original model overpredicted adult (≥ 18 years old) chronic HCV infection prevalence for 2021 (2.7%; 95% credible interval (CrI): 1.9–3.5%) compared with a 2021 serosurvey (1.8%; 95% confidence interval (CI): 1.3–2.4%). Weighted model projections estimated a 60% decrease in HCV infection incidence by March 2022, with an absolute incidence of 66 (95% CrI: 34–131) per 100,000 person-years (overall population). Between May 2015 and March 2022, 9,186 (95% CrI: 5,396–16,720) infections and 842 (95% CrI: 489–1,324) deaths were averted. The COVID-19 pandemic resulted in 13,344 (95% CrI: 13,236–13,437) fewer treatments and 438 (95% CrI: 223-744) fewer averted infections by March 2022. Conclusion Results support the programme’s high effectiveness. At current treatment rate (406/month), 90% reductions in prevalence and incidence in Georgia are achievable by 2030.

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Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis

Cited by 34 publications

References 136 publications

Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

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