Titre : | Scaling-up HCV prevention and treatment interventions in rural United States - model projections for tackling an increasing epidemic (2018) |
Auteurs : | H. FRASER ; J. ZIBBELL ; T. HOERGER ; S. HARIRI ; C. VELLOZZI ; N. K. MARTIN ; A. H. KRAL ; M. HICKMAN ; J. W. WARD ; P. VICKERMAN |
Type de document : | Article : Périodique |
Dans : | Addiction (Vol.113, n°1, January 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 |
Discipline : | MAL (Maladies infectieuses / Infectious diseases) |
Mots-clés : |
Thésaurus géographique ETATS-UNISThésaurus mots-clés HEPATITE ; PREVENTION ; REDUCTION DES RISQUES ET DES DOMMAGES ; USAGER ; MILIEU RURAL ; MODELE STATISTIQUE ; EPIDEMIOLOGIE ; INFECTION |
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. Participants: PWID. 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 |
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