Social and Community Medicine, University of Bristol, Bristol, UK.
RTI International, Research Triangle Park, NC, USA.
Addiction. 2018 Jan;113(1):173-182. doi: 10.1111/add.13948. Epub 2017 Sep 20.
Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting.
An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana.
Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015.
PWID.
Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting.
To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment.
Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
需要采取有效策略来应对美国农村地区注射吸毒者（PWID）中丙型肝炎病毒（HCV）感染的急剧增加。我们确定了 HCV 治疗的扩大规模，以及 HCV 预防干预措施的扩大规模，以实现到 2025 年和 2030 年，美国农村地区 HCV 慢性流行率或发病率降低 90%。
一种 HCV 传播的常微分方程模型，根据主要来自印第安纳州 HIV 爆发调查的 HCV 流行病学数据进行校准。
印第安纳州斯科特县（人口 24181 人），美国农村地区，基线干预措施微不足道，自 2010 年以来 HCV 疫情不断增加，2015 年 PWID 的慢性 HCV 流行率为 55.3%。
PWID。
为了实现 2025/30 年 HCV 慢性流行率或发病率降低 90%，每 1000 名 PWID 所需的 HCV 治疗年度次数（以及初始年度受感染 PWID 的治疗百分比），要么扩大注射器服务计划（SSP）和药物辅助治疗（MAT）至 50%的覆盖率，要么不扩大。敏感性分析考虑了如果不重新治疗再感染，是否可以实现这种影响，以及由于这种情况下疫情的增加，是否需要更大的干预措施扩大。
如果不扩大 MAT 和 SSP，要到 2030 年实现发病率和流行率降低 90%，则每年需要对 1000 名 PWID 中的 159 人（最初是 24.9%的受感染 PWID）进行 HCV 治疗。然而，如果扩大 MAT 和 SSP，则治疗率减半（每年每 1000 人 89 次或 14.5%）。如果到 2025 年扩大 MAT 和 SSP，则每年需要对 1000 名 PWID 中的 121 人（19.9%）进行治疗。这些治疗需求是稳定疫情时的三倍，如果不进行重新治疗，这些目标是无法实现的。
需要扩大 HCV 治疗和预防干预措施的规模，才能到 2025 年和 2030 年，将美国印第安纳州农村地区 HCV 发病率和流行率的上升负担降低 90%。
