Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.
Int J Drug Policy. 2023 Jun;116:104026. doi: 10.1016/j.drugpo.2023.104026. Epub 2023 Apr 7.
In Montreal (Canada), high hepatitis C virus (HCV) seroincidence (21 per 100 person-years in 2017) persists among people who have injected drugs (PWID) despite relatively high testing rates and coverage of needle and syringe programs (NSP) and opioid agonist therapy (OAT). We assessed the potential of interventions to achieve HCV elimination (80% incidence reduction and 65% reduction in HCV-related mortality between 2015 and 2030) in the context of COVID-19 disruptions among all PWID and PWID living with HIV.
Using a dynamic model of HCV-HIV co-transmission, we simulated increases in NSP (from 82% to 95%) and OAT (from 33% to 40%) coverage, HCV testing (every 6 months), or treatment rate (100 per 100 person-years) starting in 2022 among all PWID and PWID living with HIV. We also modeled treatment scale-up among active PWID only (i.e., people who report injecting in the past six months). We reduced intervention levels in 2020-2021 due to COVID-19-related disruptions. Outcomes included HCV incidence, prevalence, and mortality, and proportions of averted chronic HCV infections and deaths.
COVID-19-related disruptions could have caused temporary rebounds in HCV transmission. Further increasing NSP/OAT or HCV testing had little impact on incidence. Scaling-up treatment among all PWID achieved incidence and mortality targets among all PWID and PWID living with HIV. Focusing treatment on active PWID could achieve elimination, yet fewer projected deaths were averted (36% versus 48%).
HCV treatment scale-up among all PWID will be required to eliminate HCV in high-incidence and prevalence settings. Achieving elimination by 2030 will entail concerted efforts to restore and enhance pre-pandemic levels of HCV prevention and care.
在加拿大的蒙特利尔，尽管毒品注射者（PWID）的检测率和覆盖面较高，包括针具交换项目（NSP）和阿片类物质激动剂治疗（OAT），但丙型肝炎病毒（HCV）血清阳性率（2017 年每 100 人年 21 例）仍然较高。我们评估了在 COVID-19 大流行期间，所有 PWID 和 HIV 合并感染的 PWID 中，通过干预措施实现 HCV 消除（2015 年至 2030 年期间发病率降低 80%，HCV 相关死亡率降低 65%）的潜力。
我们使用 HCV-HIV 共传播的动态模型，模拟从 2022 年开始，所有 PWID 和 HIV 合并感染的 PWID 中 NSP（从 82%增加到 95%）和 OAT（从 33%增加到 40%）覆盖率、HCV 检测（每 6 个月一次）或治疗率（每 100 人年 100 例）的增加。我们还对仅活跃的 PWID（即过去六个月报告注射毒品的人）进行了治疗规模扩大的建模。由于 COVID-19 相关的中断，我们减少了 2020-2021 年的干预水平。结果包括 HCV 的发病率、患病率和死亡率，以及避免慢性 HCV 感染和死亡的比例。
COVID-19 相关的中断可能导致 HCV 传播的暂时反弹。进一步增加 NSP/OAT 或 HCV 检测对发病率的影响很小。所有 PWID 治疗的扩大可以实现所有 PWID 和 HIV 合并感染的 PWID 的发病率和死亡率目标。将治疗重点放在活跃的 PWID 上可以实现消除，但预计死亡人数减少（36%对 48%）。
需要在所有 PWID 中扩大 HCV 治疗规模，以在高发病率和高流行率的环境中消除 HCV。要在 2030 年实现消除，需要协调努力恢复和加强 HCV 预防和护理的大流行前水平。
