TY - JOUR
T1 - Is hepatitis C virus (HCV) elimination achievable among people who inject drugs in Tijuana, Mexico? A modeling analysis
AU - Marquez, Lara K.
AU - Cepeda, Javier A.
AU - Bórquez, Annick
AU - Strathdee, Steffanie A.
AU - Gonzalez-Zúñiga, Patricia E.
AU - Fleiz, Clara
AU - Rafful, Claudia
AU - Garfein, Richard S.
AU - Kiene, Susan M.
AU - Brodine, Stephanie
AU - Martin, Natasha K.
N1 - Funding Information:
LM was supported by the UC San Diego Frontiers of Innovation Graduate Fellowship (FISP/CRES), San Diego, CA. NM acknowledges funding from the National Institute for Drug Abuse (R01 DA03773 and R01 AI147490), the National Institute for Allergy and Infectious Diseases (R01 AI147490), and the University of San Diego Center for AIDS Research (CFAR), a NIH funded program (P30 AI036214). CR was supported by the CIHR Postdoctoral Research Fellowship.
Funding Information:
NM has received unrestricted research grants from Gilead and Merck unrelated to this work.
Publisher Copyright:
© 2020
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
KW - Hepatitis C elimination
KW - Modeling
KW - People who inject drugs
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U2 - 10.1016/j.drugpo.2020.102710
DO - 10.1016/j.drugpo.2020.102710
M3 - Article
C2 - 32165050
AN - SCOPUS:85081257508
SN - 0955-3959
VL - 88
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
M1 - 102710
ER -