Scaling-Up Prevention and Treatment Interventions for Achieving HCV Elimination

A modest scale-up of hepatitis C virus (HCV) treatment, along with medication-assisted treatment and syringe service programs where needed, can reverse the expanding HCV burden in the United States and reach elimination goals within 10 to 15 years, according to study results published in the American Journal of Epidemiology.¹

In the United States, approximately, 3.5 million people are infected with HCV and the majority (>80%) of transmission occurs in people who inject drugs.^2,3 Harm reduction services for people who inject drugs, such as medication-assisted treatment and syringe service programs can reduce the risk for HCV transmission,^4,5 and all-oral direct-acting antivirals can cure HCV in 8 to 12 weeks.^6,7 The demographics of people who inject drugs and the availability of harm reduction services varies across the United States.^8-12 Rural settings tend to have an expanding younger demographic of people who inject drugs, with increasing HCV transmission compared with urban areas.^12,13 Therefore, using modelling researchers compared the impact of scaling up prevention and treatment interventions on HCV transmission among people who inject drugs in rural Perry County, Kentucky, and urban San Francisco, California, where HCV sero-prevalence in people who inject drugs is >50%.¹ They modeled the proportion of people who are HCV-infected and inject drugs in need of HCV treatment annually to reduce HCV incidence by 90% by 2030, with and without scale-up of medication-assisted treatment (50% coverage, both settings) and scale-up of syringe service programs (Perry County only) from 2017. The researchers found that in urban areas with existing moderate to high coverage of harm reduction services, HCV treatment should be scaled up to reduce transmission. However, in areas with low coverage of harm reduction services, scaling up medication-assisted treatment and syringe service programs is also necessary to reduce the incidence of new and re-infections.

The investigators concluded that, “Field studies are required to demonstrate the feasibility and impact of these strategies, helping inform [harm reduction] HR policy changes, so enabling the U.S. to reduce HCV as a public health threat.”¹

References
1. Fraser H, Vellozzi C, Hoerger TJ, et al. Scaling-up hepatitis C prevention and treatment interventions for achieving elimination in the United States – a rural and urban comparison [published online May 31, 2019]. Am J Epidemiol. doi: 10.1093/aje/kwz097

2. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 2015;62(5):1353-1363.

3. Surveillance for Viral Hepatitis – United States, 2015. Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/statistics/2015surveillance/pdfs/2015HepSurveillanceRpt.pdf Updated 2017. Accessed June 26, 2019.

4. Turner KM, Hutchinson S, Vickerman P, et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 2011;106(11):1978-1788.

5. Platt L, Minozzi S, Reed J, et al. Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta‐analysis. Addiction. 2018;113(3):545-563.

6. Dore GJ, Feld JJ. Hepatitis C virus therapeutic development: in pursuit of “perfectovir”.
Clin Infect Dis. 2015;60(12):1829-1836.

7. Recommendations for testing, managing, and treating Hepatitis C. American Association for the Study of Liver Diseases, Infectious Diseases Society of America website. www.hcvguidelines.org/evaluate. Accessed  June 26, 2019.

8. HIV infection, risk, prevention, and testing behaviors among persons who inject drugs—national HIV behavioral surveillance: Injection drug use, 20 U.S. Cities, 2012. HIV Surveillance Special Report 11 Revised Edition. Centers for Disease Control and Prevention website.  www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-HSSR_NHBS_PWID_2012.pdf. Accessed September 3, 2018.

9. HIV infection, risk, prevention, and testing behaviors among persons who inject drugs—national HIV behavioral surveillance: Injection drug use, 20 U.S. Cities, 2015. HIV Surveillance Special Report 18. Centers for Disease Control and Prevention website. www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-hssr-nhbs-pwid-2015.pdf. Accessed January 16, 2019.

10. Canary L, Hariri S, Campbell C, et al. Geographic disparities in access to syringe services programs among young persons with hepatitis C virus infection in the United States. Clin Infect Dis. 2017;65(3):514-517.

11. Rosenberg ES, Hall EW, Sullivan PS, et al. Estimation of state-level prevalence of hepatitis C virus infection, US states and District of Columbia, 2010. Clin Infect Dis. 2017;64(11):1573-1581.

12. Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clin Infect Dis. 2014;59(10):1411-1419.

13. Havens JR, Lofwall MR, Frost SD, Oser CB, Leukefeld CG, Crosby RA. Individual and network factors associated with prevalent hepatitis C infection among rural Appalachian injection drug users. Am J Public Health. 2013;103(1):e44-e52.