Title :

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

Author(s) :

Cousien, Anthony [Auteur]
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Leclerc, Pascale [Auteur]
Morissette, Carole [Auteur]
Bruneau, Julie [Auteur]
Roy, Élise [Auteur]
Faculté de médecine et des sciences de la santé [Sherbrooke] [UdeS]
Tran, Chi [Auteur]
Laboratoire Paul Painlevé - UMR 8524 [LPP]
Yazdanpanah, Yazdan [Auteur]
Service des maladies infectieuses et tropicales
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Cox, Joseph [Auteur correspondant]
Department of Epidemiology, Biostatistics and Occupational Health [Montréal]

Journal title :

BMC infectious diseases

Pages :

162

Publisher :

BioMed Central

Publication date :

2017-12

ISSN :

1471-2334

English keyword(s) :

Direct-acting antiviral
People who inject drugs
Dynamic model
HCV elimination
Treatment initiation criteria
Cascade of care

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

AbstractBackgroundHCV 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” ...
Show more >AbstractBackgroundHCV 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.Show less >

Language :

Anglais

Popular science :

Non

Collections :

• Laboratoire Paul Painlevé - UMR 8524

Source :

Harvested from HAL