Author information
1
University of Bristol, Bristol, UK. Electronic address: hannah.fraser@bristol.ac.uk.
2
Division of Global Public Health, University of California San Diego, San Diego, USA; University of Bristol, Bristol, UK.
3
National Institute for Health and Welfare, Helsinki, Finland.
4
Institut National de la Sante de la Recherche Medicale, Marseille, France; University of Aix-Marseille, France; ORS, PACA, Marseille, France.
5
University of Oslo, Oslo, Norway; Akershus University Hospial, Lørenskog, Norway.
6
University of Dundee, Dundee, Scotland, United Kingdom.
7
Health Protection Scotland, Glasgow, Scotland, United Kingdom.
8
Glasgow Caledonian University, Glasgow, Scotland, United Kingdom; Health Protection Scotland, Glasgow, Scotland, United Kingdom.
9
French Institute for Public Health Surveillance, St Maurice, France; CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France.
10
Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
11
Public Health Service of Amsterdam, Amsterdam, Netherlands; University Medical Centre Utrecht, Utrecht, Netherlands.
12
University of Ljubljana, Ljubljana, Slovenia; University Medical Centre Ljubljana, Ljubljana, Slovenia.
13
University of Oslo, Oslo, Norway.
14
National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic; Charles University Prague and General University Hospital in Prague, Czech Republic; National Institute of Mental Health, Czech Republic.
15
Odense University Hospital, Odense, Denmark.
16
Public Health Service of Amsterdam, Amsterdam, Netherlands; Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
17
Health North, Bremen, Germany; University of Hamburg, Hamburg, Germany.
18
Ziekenhuis Oost Limburg, Genk, Belgium; Hasselt University, Diepenbeek, Belgium; University Hospital Leuven, Leuven, Belgium.
19
University of Hamburg, Hamburg, Germany.
20
Public Health Service of Amsterdam, Amsterdam, Netherlands.
21
Robert Koch Institute, Berlin, Germany.
22
University of Bristol, Bristol, UK.
Abstract
BACKGROUND:
Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes (NSP) across Europe over the next 10 years.
METHODS:
We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence among PWID.
RESULTS:
At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. Current treatment rates using new direct acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia and Amsterdam. Doubling HCV-treatment rates will reduce prevalence in other sites (12-24%, Belgium/Denmark/Hamburg/Norway/Scotland) but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate to substantial increases in current treatment rates are required to achieve the same impact elsewhere, from 1.4-3 times (Czech Republic/France), 5-17 times (France/Scotland/Hamburg/Norway/Denmark/Belgium/Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%.
CONCLUSIONS:
Scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. Lay summary Measuring the amount of HCV in the population of people who inject drugs is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially opioid substitution treatment and provision of sterile injecting equipment).