Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America.
Decision and Infrastructure Sciences, Argonne National Laboratory, Argonne, Illinois, United States of America.
PLoS One. 2022 Mar 10;17(3):e0264983. doi: 10.1371/journal.pone.0264983. eCollection 2022.
Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease and mortality worldwide. Direct-acting antiviral (DAA) therapy leads to high cure rates. However, persons who inject drugs (PWID) are at risk for reinfection after cure and may require multiple DAA treatments to reach the World Health Organization's (WHO) goal of HCV elimination by 2030. Using an agent-based model (ABM) that accounts for the complex interplay of demographic factors, risk behaviors, social networks, and geographic location for HCV transmission among PWID, we examined the combination(s) of DAA enrollment (2.5%, 5%, 7.5%, 10%), adherence (60%, 70%, 80%, 90%) and frequency of DAA treatment courses needed to achieve the WHO's goal of reducing incident chronic infections by 90% by 2030 among a large population of PWID from Chicago, IL and surrounding suburbs. We also estimated the economic DAA costs associated with each scenario. Our results indicate that a DAA treatment rate of >7.5% per year with 90% adherence results in 75% of enrolled PWID requiring only a single DAA course; however 19% would require 2 courses, 5%, 3 courses and <2%, 4 courses, with an overall DAA cost of $325 million to achieve the WHO goal in metropolitan Chicago. We estimate a 28% increase in the overall DAA cost under low adherence (70%) compared to high adherence (90%). Our modeling results have important public health implications for HCV elimination among U.S. PWID. Using a range of feasible treatment enrollment and adherence rates, we report robust findings supporting the need to address re-exposure and reinfection among PWID to reduce HCV incidence.
丙型肝炎病毒（HCV）感染是全球慢性肝病和死亡的主要原因。直接作用抗病毒（DAA）治疗可带来高治愈率。然而，治愈后的吸毒者（PWID）有再次感染的风险，可能需要多次 DAA 治疗才能达到世界卫生组织（WHO）到 2030 年消除 HCV 的目标。本研究使用一种基于主体的模型（ABM），该模型考虑了 PWID 之间 HCV 传播的人口统计学因素、风险行为、社交网络和地理位置的复杂相互作用，研究了 DAA 参与率（2.5%、5%、7.5%、10%）、治疗方案的依从性（60%、70%、80%、90%）以及需要多少次 DAA 治疗方案来实现 WHO 在 2030 年之前将新发生的慢性感染减少 90%的目标，研究对象为来自伊利诺伊州芝加哥及其周边郊区的大量 PWID。我们还估计了与每种情况相关的 DAA 经济成本。研究结果表明，每年 DAA 治疗率超过 7.5%，且依从性为 90%，则 75%的登记 PWID 只需接受单次 DAA 治疗；然而，19%的人需要接受 2 次治疗，5%、5%、3%和<2%、4%的人需要接受 3 次治疗，4%的人需要接受 4 次治疗，这将使在大都市芝加哥实现 WHO 目标的 DAA 总成本达到 3.25 亿美元。我们估计，在低依从性（70%）下，DAA 的总成本比高依从性（90%）增加了 28%。我们的模型结果对美国 PWID 消除 HCV 具有重要的公共卫生意义。使用一系列可行的治疗参与率和依从率，我们报告了有力的发现，支持解决 PWID 中再暴露和再感染的问题，以降低 HCV 的发病率。
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