Is hepatitis C virus (HCV) elimination achievable among people who inject drugs in Tijuana, Mexico? A modeling analysis

Lara K. Marquez, Javier A. Cepeda, Annick Bórquez, Steffanie A. Strathdee, Patricia E. Gonzalez-Zúñiga, Clara Fleiz, Claudia Rafful, Richard S. Garfein, Susan M. Kiene, Stephanie Brodine, Natasha K. Martin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: In 2019, Mexico became the first Latin American country committed to hepatitis C virus (HCV) elimination, but the amount of intervention scale-up required is unclear. In Tijuana, HCV among people who inject drugs (PWID) is high; yet there is minimal and intermittent harm reduction, and involuntary exposure to compulsory abstinence programs (CAP) occurs which is associated with increased HCV risk. We determined what combination intervention scale-up can achieve HCV elimination among current and former PWID in Tijuana. Methods: We constructed a dynamic, deterministic model of HCV transmission, disease progression, and harm reduction among current and former PWID parameterized to Tijuana (~10,000 current PWID, 90% HCV seropositive, minimal opiate agonist therapy [OAT] or high coverage needle/syringe programs [HCNSP]). We evaluated the number of direct-acting antiviral (DAA) treatments needed from 2019 to achieve elimination targets (80% incidence reduction, 65% mortality reduction by 2030) with: (a) DAAs alone, (b) DAAs plus scale-up of OAT+HCNSP (up to 50% coverage of OAT and HCNSP separately, producing 25% of PWID receiving both), (c) DAAs plus CAP scale-up to 50%. Scenarios examined the number of DAAs required if prioritized to current PWID or provided regardless of current injection status, and impact of harm reduction interruptions. Results: Modeling suggests among ~30,000 current and former PWID in Tijuana, 16,160 (95%CI: 12,770–21,610) have chronic HCV. DAA scale-up can achieve the incidence target, requiring 770 treatments/year (95%CI: 640–970) if prioritized to current PWID. 40% fewer DAAs are required with OAT+HCNSP scale-up to 50% among PWID, whereas more are required with involuntary CAP scale-up. Both targets can only be achieved through treating both current and former PWID (1,710 treatments/year), and impact is reduced with harm reduction interruptions. Conclusions: Elimination targets are achievable in Tijuana through scale-up of harm reduction and DAA therapy, whereas involuntary CAP and harm reduction interruptions hamper elimination.

Original languageEnglish (US)
Article number102710
JournalInternational Journal of Drug Policy
StatePublished - Feb 2021
Externally publishedYes


  • Hepatitis C elimination
  • Modeling
  • People who inject drugs

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy


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