Progress towards hepatitis C virus elimination in high‐income countries: An updated analysis

Abstract

BACKGROUND & AIMS Elimination of HCV by 2030, as defined by the World Health Organization (WHO), is attainable with the availability of highly efficacious therapies. This study reports progress made in the timing of HCV elimination in 45 high‐income countries between 2017 and 2019. METHODS Disease progression models of HCV infection for each country were updated with latest data on chronic HCV prevalence, and annual diagnosis and treatment levels, assumed to remain constant in the future. Modelled outcomes were analysed to determine the year in which each country would meet the WHO 2030 elimination targets. RESULTS Of the 45 countries studied, 11 (Australia, Canada, France, Germany, Iceland, Italy, Japan, Spain, Sweden, Switzerland, and United Kingdom) are on track to meet WHO's elimination targets by 2030; five (Austria, Malta, Netherlands, New Zealand, and South Korea) by 2040; and two (Saudi Arabia and Taiwan) by 2050. The remaining 27 countries are not expected to achieve elimination before 2050. Compared to progress in 2017, South Korea is no longer on track to eliminate HCV by 2030, three (Canada, Germany, and Sweden) are now on track, and most countries (30) saw no change. CONCLUSIONS Assuming high‐income countries will maintain current levels of diagnosis and treatment, only 24% are on track to eliminate HCV by 2030, and 60% are off track by at least 20 years. If current levels of diagnosis and treatment continue falling, achieving WHO's 2030 targets will be more challenging. With less than ten years remaining, screening and treatment expansion is crucial to meet WHO's HCV elimination targets.

A meta-analysis of 20 years of data on people who inject drugs in metropolitan Chicago to inform computational modeling

“…Results were similar for regular employment except that Chicago residence decreased the likelihood of regular employment (OR = 0.76, 95% CI 0.61 – 0.94). The average monthly income was $1,369, with higher income reported by non-Hispanic white PWID (Chi2[1] = 12.84, p = .0003), and decreasing with increasing age (Chi2[3] = 126.91, p<.0001). An estimated 39% of PWID reported being homeless; those who resided in Chicago were more likely to report being homeless (OR = 1.42, 95% CI 1.16 – 1.75), while non-Hispanic Black PWID were less likely to be homeless (35% vs. 44% non-Hispanic white, OR = 0.68, 95% CI 0.56 – 0.83).…”

“…Over half of PWID (58%) reported use of a SSP, and 13% reported current substance use treatment. Women (OR = 1.23, 95% CI 1.04 – 1.46) and PWID over 25 (Chi2[1] = 10.07, p = .0015) were more likely to use a SSP, while non-Hispanic Black PWID were less likely than others to use a SSP after adjusting for age (Chi2[3]=22.80, p<.0001). PWID who resided in Chicago were marginally more likely to report using a SSP (OR = 1.28, 95% CI 1.00 – 1.64).…”

“…There were also significant effects of age on all three behaviors. The likelihood of recent equipment sharing decreased with age (Chi2[3]=10.80, p=.01), from 0.69 in the youngest (18-24) category to 0.61 and 0.58 in the intermediate age categories, and 0.56 in the oldest (≥ 45) category. The likelihood of recent RSS also decreased with age (Chi2[3] = 15.18, p=.002), from 0.37 for the 18-24 category to 0.31 and 0.28 in the intermediate categories, and 0.23 for 45 and older.…”

“…The likelihood of recent equipment sharing decreased with age (Chi2[3]=10.80, p=.01), from 0.69 in the youngest (18-24) category to 0.61 and 0.58 in the intermediate age categories, and 0.56 in the oldest (≥ 45) category. The likelihood of recent RSS also decreased with age (Chi2[3] = 15.18, p=.002), from 0.37 for the 18-24 category to 0.31 and 0.28 in the intermediate categories, and 0.23 for 45 and older. The likelihood of recent DSS was significantly lower for the oldest age category (≥ 45) compared to all other categories (Chi2[1]=31.02, p<.0001), dropping from 0.42 in the youngest category and 0.41 and 0.39 in the intermediate categories, to 0.29 in the oldest category.…”

“…One hundred networks were simulated from the fitted model and the distributions of the simulated parameters were compared to the targets estimated from the meta-analysis above. .07, p = .0015) were more likely to use a SSP, while non-Hispanic Black PWID were less likely than others to use a SSP after adjusting for age (Chi2 [3]=22.80, p<.0001). PWID who resided in Chicago were marginally more likely to report using a SSP (OR = 1.28, 95% CI 1.00 -1.64).…”