Fang Kailu, Wang Hong-Liang, Lin Yushi, Li Shuwen, Wu Jie
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
Infect Dis Ther. 2023 Apr;12(4):1043-1055. doi: 10.1007/s40121-023-00779-0. Epub 2023 Mar 9.
Injection drug use is the main transmission route of hepatitis C virus (HCV) in China. The prevalence of HCV remains high at 40-50% among people who inject drugs (PWID). We developed a mathematical model to predict the impacts of different HCV intervention strategies on the HCV burden in Chinese PWID by 2030.
We developed a dynamic deterministic mathematical model to simulate the transmission of HCV among PWID in China between 2016 and 2030, using domestic data based on the real cascade of HCV care. We considered various intervention scenarios, including treatment regimens, harm reduction program (HRP) coverage, enhanced testing and referral for treatment.
HCV incidence will exhibit a gradual but slow declining trend from 12,970 in 2016 to 11,761 in 2030 based on current screening and treatment practices among PWID (scenario 1). Scaled-up HCV screening and treatment integrated with HRPs (scenario 8) demonstrated the most substantial reduction in HCV burden, being the only intervention scenario that could achieve the World Health Organization's (WHO's) HCV elimination target. Specifically, the HCV incidence in 2030 is projected to be reduced by 81.42%, and HCV-related deaths are projected to be reduced by 91.94%.
Our study indicates that achieving WHO elimination targets is an extremely challenging goal that requires substantial improvements in HCV testing and treatment among PWID (scenario S8). The findings suggest that coordinated improvements in testing, treatment, and harm reduction programs could greatly reduce the HCV burden among PWID in China, and urgent policy changes are needed to integrate HCV testing and treatment into existing HRPs.
注射吸毒是中国丙型肝炎病毒（HCV）的主要传播途径。在注射吸毒者（PWID）中，HCV流行率仍高达40%-50%。我们建立了一个数学模型，以预测不同HCV干预策略到2030年对中国PWID中HCV负担的影响。
我们建立了一个动态确定性数学模型，利用基于HCV实际治疗流程的国内数据，模拟2016年至2030年中国PWID中HCV的传播情况。我们考虑了各种干预情景，包括治疗方案、减少伤害项目（HRP）覆盖范围、加强检测和转诊治疗。
基于目前PWID的筛查和治疗实践（情景1），HCV发病率将呈现逐渐但缓慢下降的趋势，从2016年的12970例降至2030年的11761例。扩大HCV筛查和治疗并与HRP相结合（情景8）显示出HCV负担的最大幅度降低，是唯一能够实现世界卫生组织（WHO）HCV消除目标的干预情景。具体而言，预计2030年HCV发病率将降低81.42%，与HCV相关的死亡人数预计将降低91.94%。
我们的研究表明，实现WHO消除目标是一个极具挑战性的目标，需要大幅改善PWID中的HCV检测和治疗（情景S8）。研究结果表明，在检测、治疗和减少伤害项目方面进行协同改进，可以大大降低中国PWID中的HCV负担，并且需要紧急改变政策，将HCV检测和治疗纳入现有的HRP中。
