Modeling hepatitis C micro-elimination among people who inject drugs with direct-acting antivirals in metropolitan Chicago

Abstract

Hepatitis C (HCV) is a leading cause of chronic liver disease and mortality worldwide. Persons who inject drugs (PWID) are at the highest risk for acquiring and transmitting HCV infection. We developed an agent-based model (ABM) to identify and optimize direct-acting antiviral (DAA) therapy scale-up and treatment strategies for achieving the World Health Organization (WHO) goals of HCV elimination by the year 2030. DAA is highly efficacious, but may require re-treatment particularly among PWID who at risk for reinfection after cure. Using an ABM approach, we predict that this prohibition will jeopardize achieving the WHO's goal of reducing 90% of HCV incidence by 2030. We found that DAA scale-up rates of greater than or equal to 5% per year can achieve the WHO target of 90% incidence reduction. Our model simulations underscore the importance of DAA scale-up that includes re-treatment of re-infected individuals in order to achieve significant reductions in incidence.