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Auteur H. FRASER
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Scaling-up HCV prevention and treatment interventions in rural United States - model projections for tackling an increasing epidemic / H. FRASER ; J. ZIBBELL ; T. HOERGER ; S. HARIRI ; C. VELLOZZI ; N. K. MARTIN ; A. H. KRAL ; M. HICKMAN ; J. W. WARD ; P. VICKERMAN in Addiction, Vol.113, n°1 (January 2018)
Titre : Scaling-up HCV prevention and treatment interventions in rural United States - model projections for tackling an increasing epidemic Type de document : Périodique Auteurs : H. FRASER ; J. ZIBBELL ; T. HOERGER ; S. HARIRI ; C. VELLOZZI ; N. K. MARTIN ; A. H. KRAL ; M. HICKMAN ; J. W. WARD ; P. VICKERMAN Année de publication : 2018 Article en page(s) : 173-182 Note générale : Commentary: Evidence base for harm reduction services - the urban-rural divide. Lancaster K.E., Malvestutto C.D., Miller W.C., Go V.F., p. 183-184. Langues : Anglais (eng) Mots-clés : Thésaurus Géographique
HEPATITE ; PREVENTION ; REDUCTION DES RISQUES ; USAGER ; MILIEU RURAL ; MODELE STATISTIQUE ; EPIDEMIOLOGIE ; INFECTION
Discipline : MAL Maladies infectieuses / Infectious diseases Résumé : Background and aims: Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting.
Design: An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana.
Setting: Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015.
Measurements: Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting.
Findings: To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment.
Conclusions: Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
Domaine : Drogues illicites / Illicit drugs Refs biblio. : 61 Affiliation : Social and Community Medicine, University of Bristol, Bristol, UK Cote : Abonnement Permalink :
in Addiction > Vol.113, n°1 (January 2018) . - 173-182[article]