The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study

Abstract

BackgroundHCV transmission remains high in people who inject drugs (PWID) in Montréal. New direct-acting antivirals (DAAs), highly effective and more tolerable than previous regimens, make a “Treatment as Prevention” (TasP) strategy more feasible. This study assesses how improvements in the cascade of care could impact hepatitis C burden among PWID in Montréal.MethodsWe used a dynamic model to simulate HCV incidence and prevalence after 10 years, and cirrhosis complications after 10 and 40 years. Eight scenarios of improved cascade of care were examined.ResultsUsing a baseline incidence and prevalence of 22.1/100 person-years (PY) and 53.1%, implementing the current cascade of care using DAAs would lead to HCV incidence and prevalence estimates at 10 years of 9.4/100PY and 55.8%, respectively. Increasing the treatment initiation rate from 5%/year initially to 20%/year resulted in large decreases in incidence (6.4/100PY), prevalence (36.6%), and cirrhosis complications (−18%/-37% after 10/40 years). When restricting treatment to fibrosis level ≥ F2 instead of F0 (reference scenario), such decreases in HCV occurrence were unreachable. Improving the whole cascade of care led to the greatest effect by halving both the incidence and prevalence at 10 years, and the number of cirrhosis complications after 40 years.ConclusionsThe current level of treatment access in Montréal is limiting a massive decrease in hepatitis C burden among PWID. A substantial treatment scale-up, regardless of fibrosis level, is necessary. While improving the rest of the cascade of care is necessary to optimize a TasP strategy and control the HCV epidemic, a treatment scale-up is first needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2256-5) contains supplementary material, which is available to authorized users.

Disparities in direct acting antivirals uptake in HIV‐hepatitis C co‐infected populations in Canada

“…It is also possible providers may have concerns about poor adherence and reinfections among PWID . Based on successful HCV treatment trials and economic analyses, international guidelines now recommend that treating PWID should be made a priority . We found similar SVR rates in active PWID compared to non‐PWID in a real‐world setting, further supporting international guidelines to treat PWID.…”

Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients

“…Moreover, HCV treatment outcomes are not affected by opioids [ 40 ]. Thus, considering the recently extended access to IFN-free regimens, such programs might decrease the incidence of HCV among patients with IVDA [ 41 ].…”

Long-Term Impact of Direct-Acting Antiviral Agent Therapy in HCV Cirrhosis: Critical Review

“…Similar modeling studies based on North American and European datasets support that elimination will be most rapidly achieved by enhancing treatment uptake among PWIDs. [105][106][107][108] Data also support that TAP is cost-effective. 108,109 HCV treatment programs within prisons, where there is a high prevalence of HCV worldwide, are also cost-effective and can have favorable effects on reducing community HCV prevalence at large.…”