Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis

Carlos D. Rivera Saldana; Daniela Abramovitz; Leo Beletsky; Annick Borquez; Susan Kiene; Lara K. Marquez; Thomas Patton; Steffanie Strathdee; María Luisa Zúñiga; Natasha K. Martin; Javier Cepeda

doi:10.1111/add.16203

Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis

Carlos D. Rivera Saldana, Daniela Abramovitz, Leo Beletsky, Annick Borquez, Susan Kiene, Lara K. Marquez, Thomas Patton, Steffanie Strathdee, María Luisa Zúñiga, Natasha K. Martin, Javier Cepeda

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

Abstract

Background and aims: Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana. Methods: We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016–2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention. Results: Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3–29.7/100py) in 2016 to 21.1/100py (UI = 15.0–29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0–27.8/100py) by 2026 and avert 186 (32–389) new infections, 76 (UI = 12–160) cases of cirrhosis and 32 (5–73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon. Conclusions: In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.

Original language	English (US)
Pages (from-to)	1763-1774
Number of pages	12
Journal	Addiction
Volume	118
Issue number	9
DOIs	https://doi.org/10.1111/add.16203
State	Published - Sep 2023

Keywords

Epidemic modelling
HCV
PWID
Tijuana
incarceration
police education

ASJC Scopus subject areas

Psychiatry and Mental health
Medicine (miscellaneous)

Access to Document

10.1111/add.16203

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Rivera Saldana, C. D., Abramovitz, D., Beletsky, L., Borquez, A., Kiene, S., Marquez, L. K., Patton, T., Strathdee, S., Zúñiga, M. L., Martin, N. K., & Cepeda, J. (2023). Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis. Addiction, 118(9), 1763-1774. https://doi.org/10.1111/add.16203

Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis. / Rivera Saldana, Carlos D.; Abramovitz, Daniela; Beletsky, Leo et al.
In: Addiction, Vol. 118, No. 9, 09.2023, p. 1763-1774.

Research output: Contribution to journal › Article › peer-review

Rivera Saldana, CD, Abramovitz, D, Beletsky, L, Borquez, A, Kiene, S, Marquez, LK, Patton, T, Strathdee, S, Zúñiga, ML, Martin, NK & Cepeda, J 2023, 'Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis', Addiction, vol. 118, no. 9, pp. 1763-1774. https://doi.org/10.1111/add.16203

@article{f70fe7be2f964c63bd5dbbd7f5856e3f,

title = "Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis",

abstract = "Background and aims: Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana. Methods: We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016–2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention. Results: Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3–29.7/100py) in 2016 to 21.1/100py (UI = 15.0–29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0–27.8/100py) by 2026 and avert 186 (32–389) new infections, 76 (UI = 12–160) cases of cirrhosis and 32 (5–73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon. Conclusions: In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.",

keywords = "Epidemic modelling, HCV, PWID, Tijuana, incarceration, police education",

author = "{Rivera Saldana}, {Carlos D.} and Daniela Abramovitz and Leo Beletsky and Annick Borquez and Susan Kiene and Marquez, {Lara K.} and Thomas Patton and Steffanie Strathdee and Z{\'u}{\~n}iga, {Mar{\'i}a Luisa} and Martin, {Natasha K.} and Javier Cepeda",

note = "Funding Information: C.D.R.S. was supported by a UC‐MEXUS/CONACyT scholarship (28886/438572). El Cuete‐IV and S.S. were supported by the National Institute of Drug Abuse (NIDA) (R37 DA019829). N.K.M. was supported by NIDA (R01 DA03773 and R01 AI147490), The National Institute for Allergy and Infectious Diseases (R01 AI147490), and the University of California San Diego Center for AIDS research, a National Institutes of Health funded program (P30 AI036214). J.C. was supported by NIDA (K01DA043421). A.B. was supported by NIDA (DP2DA049295). L.B. was supported by NIDA (R01DA039073). L.K.M. was supported by the National Institute of Drug Abuse of the National Institutes of Health (T32 DA023356) and Fogarty International Center of the National Institutes of Health (D43TW009343) and the University of California Global Health Institute. Funding Information: C.D.R.S. was supported by a UC-MEXUS/CONACyT scholarship (28886/438572). El Cuete-IV and S.S. were supported by the National Institute of Drug Abuse (NIDA) (R37 DA019829). N.K.M. was supported by NIDA (R01 DA03773 and R01 AI147490), The National Institute for Allergy and Infectious Diseases (R01 AI147490), and the University of California San Diego Center for AIDS research, a National Institutes of Health funded program (P30 AI036214). J.C. was supported by NIDA (K01DA043421). A.B. was supported by NIDA (DP2DA049295). L.B. was supported by NIDA (R01DA039073). L.K.M. was supported by the National Institute of Drug Abuse of the National Institutes of Health (T32 DA023356) and Fogarty International Center of the National Institutes of Health (D43TW009343) and the University of California Global Health Institute. Funding Information: N.M. has received unrestricted research grants from Gilead and Merck unrelated to this work. Publisher Copyright: {\textcopyright} 2023 Society for the Study of Addiction.",

year = "2023",

month = sep,

doi = "10.1111/add.16203",

language = "English (US)",

volume = "118",

pages = "1763--1774",

journal = "Addiction",

issn = "0965-2140",

publisher = "Wiley-Blackwell",

number = "9",

}

TY - JOUR

T1 - Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico

T2 - A dynamic modeling analysis

AU - Rivera Saldana, Carlos D.

AU - Abramovitz, Daniela

AU - Beletsky, Leo

AU - Borquez, Annick

AU - Kiene, Susan

AU - Marquez, Lara K.

AU - Patton, Thomas

AU - Strathdee, Steffanie

AU - Zúñiga, María Luisa

AU - Martin, Natasha K.

AU - Cepeda, Javier

N1 - Funding Information: C.D.R.S. was supported by a UC‐MEXUS/CONACyT scholarship (28886/438572). El Cuete‐IV and S.S. were supported by the National Institute of Drug Abuse (NIDA) (R37 DA019829). N.K.M. was supported by NIDA (R01 DA03773 and R01 AI147490), The National Institute for Allergy and Infectious Diseases (R01 AI147490), and the University of California San Diego Center for AIDS research, a National Institutes of Health funded program (P30 AI036214). J.C. was supported by NIDA (K01DA043421). A.B. was supported by NIDA (DP2DA049295). L.B. was supported by NIDA (R01DA039073). L.K.M. was supported by the National Institute of Drug Abuse of the National Institutes of Health (T32 DA023356) and Fogarty International Center of the National Institutes of Health (D43TW009343) and the University of California Global Health Institute. Funding Information: C.D.R.S. was supported by a UC-MEXUS/CONACyT scholarship (28886/438572). El Cuete-IV and S.S. were supported by the National Institute of Drug Abuse (NIDA) (R37 DA019829). N.K.M. was supported by NIDA (R01 DA03773 and R01 AI147490), The National Institute for Allergy and Infectious Diseases (R01 AI147490), and the University of California San Diego Center for AIDS research, a National Institutes of Health funded program (P30 AI036214). J.C. was supported by NIDA (K01DA043421). A.B. was supported by NIDA (DP2DA049295). L.B. was supported by NIDA (R01DA039073). L.K.M. was supported by the National Institute of Drug Abuse of the National Institutes of Health (T32 DA023356) and Fogarty International Center of the National Institutes of Health (D43TW009343) and the University of California Global Health Institute. Funding Information: N.M. has received unrestricted research grants from Gilead and Merck unrelated to this work. Publisher Copyright: © 2023 Society for the Study of Addiction.

PY - 2023/9

Y1 - 2023/9

N2 - Background and aims: Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana. Methods: We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016–2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention. Results: Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3–29.7/100py) in 2016 to 21.1/100py (UI = 15.0–29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0–27.8/100py) by 2026 and avert 186 (32–389) new infections, 76 (UI = 12–160) cases of cirrhosis and 32 (5–73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon. Conclusions: In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.

AB - Background and aims: Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana. Methods: We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016–2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention. Results: Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3–29.7/100py) in 2016 to 21.1/100py (UI = 15.0–29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0–27.8/100py) by 2026 and avert 186 (32–389) new infections, 76 (UI = 12–160) cases of cirrhosis and 32 (5–73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon. Conclusions: In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.

KW - Epidemic modelling

KW - HCV

KW - PWID

KW - Tijuana

KW - incarceration

KW - police education

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SN - 0965-2140

VL - 118

SP - 1763

EP - 1774

JO - Addiction

JF - Addiction

IS - 9

ER -

Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis

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