Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK.
Population Health Sciences, University of Bristol, Bristol, UK.
Lancet Gastroenterol Hepatol. 2019 Jun;4(6):435-444. doi: 10.1016/S2468-1253(19)30085-8. Epub 2019 Apr 10.
WHO aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030. Injection drug use is an important risk factor for HCV transmission, but its contribution to country-level and global epidemics is unknown. We estimated the contribution of injection drug use to risk for HCV epidemics globally, regionally, and at country level.
We developed a dynamic deterministic HCV transmission model to simulate country-level HCV epidemics among people who inject drugs and the general population. Each country's model was calibrated using country-specific data from UN datasets and systematic reviews on the prevalence of HCV and injection drug use. The population attributable fraction of HCV transmission associated with injection drug use was estimated-defined here as the percentage of HCV infections prevented if additional HCV transmission due to injection drug use was removed between 2018 and 2030.
The model included 88 countries (85% of the global population). The model predicted 0·23% (95% credibility interval [CrI] 0·16-0·31) of the global population were injection drug users in 2017, and 8% (5-12) of prevalent HCV infections were among people who currently inject drugs. Globally, if the increased risk for HCV transmission among people who inject drugs was removed, an estimated 43% (95% CrI 25-67) of incident HCV infections would be prevented from 2018 to 2030, varying regionally. This population attributable fraction was higher in high-income countries (79%, 95% CrI 57-97) than in countries of low and middle income (38%, 24-64) and was associated with the percentage of a country's prevalent HCV infections that are among people who inject drugs.
Unsafe injecting practices among people who inject drugs contribute substantially to incident HCV infections globally. Any intervention that can reduce HCV transmission among people who inject drugs will have a pronounced effect on country-level incidence of HCV.
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世界卫生组织（WHO）旨在到 2030 年消除丙型肝炎病毒（HCV）对公共健康的威胁。注射吸毒是 HCV 传播的一个重要危险因素，但它对国家和全球流行的贡献尚不清楚。我们估计了注射吸毒对全球、区域和国家层面 HCV 流行的贡献。
我们开发了一种动态确定性 HCV 传播模型，以模拟注射吸毒者和普通人群中的国家层面 HCV 流行。每个国家的模型都使用来自联合国数据集和 HCV 流行率和注射吸毒情况系统评价的特定国家数据进行校准。注射吸毒相关 HCV 传播的人群归因分数是通过估计得出的 - 定义为如果在 2018 年至 2030 年期间消除因注射吸毒而导致的额外 HCV 传播，可预防的 HCV 感染百分比。
该模型包括 88 个国家（占全球人口的 85%）。该模型预测，2017 年全球有 0.23%（95%置信区间[CrI]0.16-0.31）的人口为注射吸毒者，8%（5-12）的 HCV 感染者目前正在注射毒品。在全球范围内，如果消除注射吸毒者中 HCV 传播的风险增加，估计 2018 年至 2030 年期间将预防 43%（95%CrI 25-67）的新 HCV 感染，区域间有所不同。高收入国家的这一人群归因分数较高（79%，95%CrI 57-97），而低收入和中等收入国家则较低（38%，24-64%），与一个国家 HCV 感染者中因注射吸毒而感染 HCV 的比例有关。
注射吸毒者的不安全注射行为对全球新的 HCV 感染有很大贡献。任何可以减少注射吸毒者中 HCV 传播的干预措施都将对国家层面 HCV 的发病率产生显著影响。
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