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Artenie A, Trickey A, Looker KJ, Stone J, Lim AG, Fraser H, Degenhardt L, Dore GJ, Grebely J, Cunningham EB, Hazarizadeh B, Low-Beer D, Luhmann N, Webb P, Hickman M, Vickerman P. Global, regional, and national estimates of hepatitis C virus (HCV) infection incidence among people who inject drugs and number of new annual HCV infections attributable to injecting drug use: a multi-stage analysis. Lancet Gastroenterol Hepatol 2025; 10:315-331. [PMID: 39993400 DOI: 10.1016/s2468-1253(24)00442-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 12/19/2024] [Accepted: 12/20/2024] [Indexed: 02/26/2025]
Abstract
BACKGROUND Measuring progress towards the WHO 2030 target for hepatitis C virus (HCV) elimination among people who inject drugs (PWID)-an incidence of two or fewer infections per 100 person-years-has been challenging due to insufficient data. We aimed to estimate HCV incidence among PWID before and since 2015, progress towards the 2030 target, and the number of new annual HCV infections attributable to injecting drug use since 2015. METHODS Four sequential steps were taken to estimate country-specific HCV incidence. First, we estimated HCV incidence from HCV antibody prevalence by duration of injecting using force-of-infection (FOI) modelling. Second, using Bayesian random-effects meta-analysis, we pooled FOI-derived estimates with any direct HCV incidence estimates from a published global meta-analysis, by country. Third, for countries with no FOI-derived or direct HCV incidence data, we applied incidence estimates from a published multi-country dynamic mathematical model. Fourth, for countries for which incidence could not be estimated using any of the aforementioned methods but that had data on overall HCV antibody prevalence (ie, not stratified by duration of injecting), we used a regression model to predict incidence based on prevalence and average duration of injecting. WHO regional and global HCV incidence, incidence rate ratios (IRRs) for 2015-21 versus pre-2015, and relative decline needed to achieve the 2030 WHO target were derived and weighted by the country-specific number of PWID at risk (ie, those who were HCV RNA-negative), provided that data from at least five countries were available within a WHO region. New annual HCV infections attributable to injecting drug use were estimated by multiplying country-specific HCV incidence for the 2015-21 period by the number of HCV RNA-negative PWID; for countries with no HCV incidence data but with evidence of an existing PWID population, incidence was imputed using the corresponding WHO regional incidence. FINDINGS For the pre-2015 period, 146 HCV incidence estimates from 81 countries were included: 52 (36%) direct, 61 (42%) FOI-derived, and 33 (23%) regression-based estimates. For 2015-21, 114 estimates from 97 countries were included: 20 (18%) direct, 18 (16%) FOI-derived, 68 (60%) dynamic model-derived, and eight (7%) regression-based. Globally, pooled HCV incidence was 13·9 per 100 person-years (95% uncertainty interval [UI] 11·9-16·4) for pre-2015 and 8·6 per 100 person-years (7·1-10·7) for 2015-21. Based on a subset of countries with data for both periods, incidence was lower in the Western Pacific (IRR 0·32 [95% UI 0·23-0·50]), Eastern Mediterranean (0·67 [0·50-0·89]), and European (0·79 [0·63-1·02]) regions in 2015-21 versus pre-2015, but no difference was observed in the Americas. Insufficient data prevented comparisons over time for the African and South-East Asia regions and globally. Based on 2015-21 HCV incidence, the global decline needed to meet the 2030 WHO target is 76·7% (95% UI 71·8-81·3), while the global number of new annual HCV infections attributable to injecting drug use was 833 760 (95% UI 493 716-1 544 395) among the 187 countries with documented evidence of a population of PWID. INTERPRETATION A substantial increase in HCV treatment and prevention is needed globally to achieve the WHO 2030 HCV elimination target for incidence among PWID. FUNDING WHO and the Wellcome Trust.
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Affiliation(s)
- Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katharine J Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Behzad Hazarizadeh
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Low-Beer
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Paige Webb
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Hilton B, De Angelis D, Mitchell H, Harris R. Heterogeneity in Risk and Implications for Hepatitis C Reinfection in People Who Inject Drugs in England. J Viral Hepat 2025; 32:e14052. [PMID: 39815998 PMCID: PMC11736538 DOI: 10.1111/jvh.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/30/2024] [Accepted: 12/04/2024] [Indexed: 01/18/2025]
Abstract
Chronic hepatitis C virus (HCV) infection is associated with significant morbidity, mortality and health economic burden. Over 90% of HCV cases in England occur in people who inject drugs (PWID). Current treatments for HCV are effective but do not protect against reinfection. This research characterised HCV infection and reinfection risk in PWID in England using 2011-2021 data from the annual, cross-sectional, bio-behavioural survey of PWID, Unlinked Anonymous Monitoring. Risk factors for HCV infection were explored using multivariable logistic regression. Shared frailty models for the force of infection (FOI) were used to estimate the risk of HCV infection throughout injecting career with unmeasured risk variation modelled using gamma-shaped frailty distributions. HCV reinfection rates were derived using the frailty distributions of FOI models fitted to UAM data. Infection rates were highest in the first year of injecting (24 per 100 person-years) but fell to between 5 and 8 infections per 100 person-years subsequently. The estimated average annual risks of HCV primary infection and reinfection were 10.0% and 14.2%, indicating a 42% higher risk of reinfection compared to primary infection. Even those with no a priori risk factors were predicted to have high rates of reinfection if previously infected. These findings support the recognition of primary HCV infection as an independent risk factor for reinfection in PWID and emphasise the importance of reducing high-risk behaviours to prevent HCV reinfection following treatment of primary infection. Public health policies must recognise the importance of preventing reinfection in efforts to reduce HCV infection prevalence.
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Affiliation(s)
- Bryn Hilton
- MPhil Population Health Sciences, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Daniela De Angelis
- MRC Biostatistics Unit, School of Clinical MedicineUniversity of CambridgeCambridgeUK
- Blood Safety, Hepatitis, STI and HIV DivisionUK Health Security AgencyLondonUK
| | - Holly Mitchell
- Blood Safety, Hepatitis, STI and HIV DivisionUK Health Security AgencyLondonUK
| | - Ross Harris
- Statistics, Modelling and Economics DepartmentUK Health Security AgencyLondonUK
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Egan C, Harris RJ, Mitchell HD, Desai M, Mandal S, De Angelis D. Analysing HCV incidence trends in people who inject drugs using serial behavioural and seroprevalence data: A modelling study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104469. [PMID: 38880700 DOI: 10.1016/j.drugpo.2024.104469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 05/14/2024] [Accepted: 05/18/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The introduction of new direct-acting antivirals for hepatitis C virus (HCV) infection, has enabled the formulation of a HCV elimination strategy led by the World Health Organisation (WHO). Guidelines for elimination of HCV target a reduction in incidence, but this is difficult to measure and needs estimating. METHODS Serial cross-sectional bio-behavioural sero-surveys provide information on an individual's infection status and duration of exposure and how these change over time. These data can be used to estimate the rate of first infection through appropriate statistical models. This study utilised updated HCV seroprevalence information from the Unlinked Anonymous Monitoring survey, an annual survey of England, Wales and Northern Ireland monitoring the prevalence of blood borne viruses in people who inject drugs. Flexible parametric and semiparametric approaches, including fractional polynomials and splines, for estimating incidence rates by exposure time and survey year were implemented and compared. RESULTS Incidence rates were shown to peak in those recently initiating injecting drug use at approximately 0.20 infections per person-year followed by a rapid reduction in the subsequent few years of injecting to approximately 0.05 infections per person-year. There was evidence of a rise in incidence rates for recent initiates between 2011 and 2020 from 0.17 infections per person-year (95 % CI, 0.16-0.19) to 0.26 infections per person-year (0.23-0.30). In those injecting for longer durations, incidence rates were stable over time. CONCLUSIONS Fractional polynomials provided an adequate fit with relatively few parameters, but splines may be preferable to ensure flexibility, in particular, to detect short-term changes in the rate of first infection over time that may be a result of treatment effects. Although chronic HCV prevalence has declined with treatment scale up over 2016-2020, there is no evidence yet of a corresponding fall in the rate of first infection. Seroprevalence and risk behaviour data can be used to estimate and monitor HCV incidence, providing insight into progress towards WHO defined elimination of HCV.
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Affiliation(s)
- Conor Egan
- MRC Biostatistics Unit, University of Cambridge, United Kingdom.
| | | | | | | | | | - Daniela De Angelis
- MRC Biostatistics Unit, University of Cambridge, United Kingdom; UK Health Security Agency, United Kingdom
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4
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Artenie A, Luhmann N, Lim AG, Fraser H, Ward Z, Stone J, MacGregor L, Walker JG, Trickey A, Marquez LK, Abu-Raddad LJ, Ayoub HH, Walsh N, Hickman M, Martin NK, Easterbrook P, Vickerman P. Methods and indicators to validate country reductions in incidence of hepatitis C virus infection to elimination levels set by WHO. Lancet Gastroenterol Hepatol 2022; 7:353-366. [PMID: 35122713 PMCID: PMC10644895 DOI: 10.1016/s2468-1253(21)00311-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/22/2022]
Abstract
One of the main goals of the 2016 Global Health Sector Strategy on viral hepatitis is the elimination of hepatitis C virus (HCV) as a public health problem by 2030, defined as an 80% reduction in incidence and 65% reduction in mortality relative to 2015. Although monitoring HCV incidence is key to validating HCV elimination, use of the gold-standard method, which involves prospective HCV retesting of people at risk, can be prohibitively resource-intensive. Additionally, few countries collected quality data in 2015 to enable an 80% decrease by 2030 to be calculated. Here, we first review different methods of monitoring HCV incidence and discuss their resource implications and applicability to various populations. Second, using mathematical models developed for various global settings, we assess whether trends in HCV chronic prevalence or HCV antibody prevalence or scale-up levels for HCV testing, treatment, and preventative interventions can be used as reliable alternative indicators to validate the HCV incidence target. Third, we discuss the advantages and disadvantages of an absolute HCV incidence target and suggest a suitable threshold. Finally, we propose three options that countries can use to validate the HCV incidence target, depending on the available surveillance infrastructure.
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Affiliation(s)
- Adelina Artenie
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Aaron G Lim
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Jack Stone
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Houssein H Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | - Nick Walsh
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Matthew Hickman
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Philippa Easterbrook
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Peter Vickerman
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Wang Y, Zhao Z, Wang M, Hannah MN, Hu Q, Rui J, Liu X, Zhu Y, Xu J, Yang M, Cui JA, Su Y, Zhao B, Chen T. The transmissibility of hepatitis C virus: a modelling study in Xiamen City, China. Epidemiol Infect 2020; 148:e291. [PMID: 33234178 PMCID: PMC7770378 DOI: 10.1017/s0950268820002885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 01/03/2023] Open
Abstract
This study aimed at estimating the transmissibility of hepatitis C. The data for hepatitis C cases were collected in six districts in Xiamen City, China from 2004 to 2018. A population-mixed susceptible-infectious-chronic-recovered (SICR) model was used to fit the data and the parameters of the model were calculated. The basic reproduction number (R0) and the number of newly transmitted cases by a primary case per month (MNI) were adopted to quantitatively assess the transmissibility of hepatitis C virus (HCV). Eleven curve estimation models were employed to predict the trends of R0 and MNI in the city. The SICR model fits the reported HCV data well (P < 0.01). The median R0 of each district in Xiamen is 0.4059. R0 follows the cubic model curve, the compound curve and the power function curve. The median MNI of each district in Xiamen is 0.0020. MNI follows the cubic model curve, the compound curve and the power function curve. The transmissibility of HCV follows a decreasing trend, which reveals that under the current policy for prevention and control, there would be a high feasibility to eliminate the transmission of HCV in the city.
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Affiliation(s)
- Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Mingzhai Wang
- Xiamen Center for Disease Control and Prevention, Xiamen361021, People's Republic of China
| | - Mikah Ngwanguong Hannah
- Medical College, Xiamen University, Xiamen City, Fujian Province, People's Republic of China
| | - Qingqing Hu
- Division of Public Health, School of Medicine, University of Utah, 201 Presidents Circle, Salt Lake City, UT84112, USA
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Jingwen Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Jing-An Cui
- Department of Mathematics, School of Science, Beijing University of Civil Engineering and Architecture, Beijing, People's Republic of China
| | - Yanhua Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen361102, People's Republic of China
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Ireland G, Mandal S, Hickman M, Ramsay M, Harris R, Simmons R. Mortality rates among individuals diagnosed with hepatitis C virus (HCV); an observational cohort study, England, 2008 to 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 31362807 PMCID: PMC6668288 DOI: 10.2807/1560-7917.es.2019.24.30.1800695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Monitoring trends in mortality for individuals diagnosed with hepatitis C virus (HCV) infection are important as we expand treatment and move towards World Health Organization elimination targets. Aim To estimate mortality rates for individuals aged ≥ 15 years diagnosed with HCV infection in England 2008–16. Methods An observational cohort study whereby death certificate information was linked to the Sentinel Surveillance of Blood Borne Virus Testing in England. Age-sex standardised mortality rates (ASMR) for individuals diagnosed with HCV infection (2008–16) were calculated and compared to the general population. Results Of 43,895 individuals with HCV infection, 2,656 (6.3%) died. All-cause ASMRs were 2,834.2 per 100,000 person years (PY), 2.3 times higher than in the general population. In individuals aged 30–69 years, all-cause mortality rates were 1,768.9 per 100,000 PY among individuals with HCV, 4.7 times higher than in the general population. ASMRs had not decreased between 2010 (2,992) and 2016 (2,340; p=0.10), with no change from 2014 (p = 0.058). ASMRs were 441.0 times higher for hepatitis, 34.4 times higher for liver cancer, 8.1 times higher for end stage liver disease and 6.4 times higher for external causes than in the general population. Conclusions Mortality was higher in individuals with diagnosed HCV infection compared to the general population, highlighting health inequalities. There is a need to improve HCV diagnosis, engagement in care and treatment rates. The high mortality from external causes highlights the importance of integrated health and social care strategies and addressing the needs of this vulnerable population.
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Affiliation(s)
- Georgina Ireland
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, United Kingdom.,National Infection Service, Public Health England, London, United Kingdom
| | - Sema Mandal
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, United Kingdom.,National Infection Service, Public Health England, London, United Kingdom
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom
| | - Mary Ramsay
- National Infection Service, Public Health England, London, United Kingdom
| | - Ross Harris
- National Infection Service, Public Health England, London, United Kingdom
| | - Ruth Simmons
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, United Kingdom.,National Infection Service, Public Health England, London, United Kingdom
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7
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Tran LT, Peacock A, Colledge S, Memedovic S, Grebely J, Leung J, Larney S, Trickey A, Stone J, Vickerman P, Hickman M, Degenhardt L. Injecting risk behaviours amongst people who inject drugs: A global multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102866. [PMID: 32712484 DOI: 10.1016/j.drugpo.2020.102866] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Injecting risk behaviour, such as receptive sharing of injecting equipment and/or re-using one's equipment, is associated with bloodborne virus transmission and infections in people who inject drugs (PWID). We aimed to estimate prevalence and correlates of injecting risk behaviours amongst PWID. METHODS We conducted a systematic review and meta-analyses to estimate country, regional, and global prevalences of injecting risk behaviours (including sharing or re-using needle/syringe and sharing other injecting equipment). Using meta-regression analyses, we determined associations between study- and country-level characteristics and receptive needle/syringe sharing. RESULTS From 61,077 identified papers and reports and 61 studies from expert consutation, evidence on injecting risk behaviours was available for 464 studies from 88 countries. Globally, it is estimated that 17.9% (95%CI: 16.2-19.6%) of PWID engaged in receptive needle/syringe sharing at last injection, 23.9% (95%CI: 21.2-26.5%) in the past month, and 32.8% (95%CI: 28.6-37.0%) in the past 6-12 months. Receptive sharing of other injecting equipment was common. Higher prevalence of receptive needle/syringe sharing in the previous month was associated with samples of PWID with a lower proportion of females, shorter average injecting duration, a higher proportion with ≥daily injecting, and older studies. Countries with lower development index, higher gender inequality and lower NSP coverage had higher proportions reporting receptive needle/syringe sharing. CONCLUSIONS High levels of injecting risk behaviours were observed amongst PWID globally, although estimates were only available for half of the countries with evidence of injecting drug use. There is a need for better capturing of injecting risk behaviours in these countries to inform implementation of harm reduction services and evaluate potential impacts of interventions to reduce risk.
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Affiliation(s)
- Lucy Thi Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Sonja Memedovic
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janni Leung
- School of Public Health, Faculty of Medicine, University of Queensland, QLD, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
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Steba GS, Koekkoek SM, Prins M, Brinkman K, Kwa D, van der Meer JTM, van der Valk M, Molenkamp R, Pollakis G, Schinkel J, Paxton WA. Bile-salt stimulated lipase polymorphisms do not associate with HCV susceptibility. Virus Res 2019; 274:197715. [PMID: 31622635 DOI: 10.1016/j.virusres.2019.197715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022]
Abstract
Bile-salt stimulate lipase (BSSL) is a glycoprotein found in human milk and blood that can potently bind DC-SIGN. The BSSL gene is highly polymorphic with a variant number of O-linked glycosylated 11 amino acid repeats at the C-terminus of the protein, encoded in exon 11 of the gene. It has been shown that certain BSSL genotypes associate with decreased HIV-1 transmission in vitro and decreased HIV-1 disease progression. The protein forms dimers and individuals possessing one high (typically 14-21) and one low (typically 7-11) number of repeat domains has been shown to have stronger binding of BSSL to DC-SIGN and HIV-1 inhibitory activity in vitro. Since we previously demonstrated that SNPs within the DC-SIGN gene can associate with risk of HCV sexual transmission and which can be linked to diminished DC-SIGN gene expression we aimed to identify whether BSSL polymorphisms associated similarly through differential binding to DC-SIGN. DNA was isolated from the HIV-1 infected MSM cohort (MOSAIC) composed of HCV multiple exposed uninfected (MEU) (N = 30) and multiple exposed HCV infected (MEI) (N = 32) individuals and from the Amsterdam cohort studies (ACS) intravenous drug using (IDU) cohort (22 MEI and 40 MEU). The numbers of repeats in exon 11 were determined by PCR with repeat distributions compared between MEI and MEU. No statistical significant difference in the copy number of exon 11 repeats, or combinations of, in the BSSL gene was observed when comparing HCV infected MEI with MEU, thus the exon 11 repeat copy number in the BSSL gene does not affect HCV susceptibility.
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Affiliation(s)
- Gaby S Steba
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sylvie M Koekkoek
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - David Kwa
- Department of Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Jan T M van der Meer
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Richard Molenkamp
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Georgios Pollakis
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Infection, Microbiology and Immunology Institute of Infection and Global Health, University of Liverpool, United Kingdom
| | - Janke Schinkel
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - William A Paxton
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Infection, Microbiology and Immunology Institute of Infection and Global Health, University of Liverpool, United Kingdom.
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Hickman M, Dillon JF, Elliott L, De Angelis D, Vickerman P, Foster G, Donnan P, Eriksen A, Flowers P, Goldberg D, Hollingworth W, Ijaz S, Liddell D, Mandal S, Martin N, Beer LJZ, Drysdale K, Fraser H, Glass R, Graham L, Gunson RN, Hamilton E, Harris H, Harris M, Harris R, Heinsbroek E, Hope V, Horwood J, Inglis SK, Innes H, Lane A, Meadows J, McAuley A, Metcalfe C, Migchelsen S, Murray A, Myring G, Palmateer NE, Presanis A, Radley A, Ramsay M, Samartsidis P, Simmons R, Sinka K, Vojt G, Ward Z, Whiteley D, Yeung A, Hutchinson SJ. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol). BMJ Open 2019; 9:e029538. [PMID: 31551376 PMCID: PMC6773339 DOI: 10.1136/bmjopen-2019-029538] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV 'Treatment as Prevention' (TasP) in PWID. METHODS AND ANALYSIS We plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome - chronic HCV prevalence in PWID - is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a 'virtual cohort' of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes. ETHICS AND DISSEMINATION Extending HCV community care pathways is covered by ethics (ERADICATE C, ISRCTN27564683, Super DOT C Trial clinicaltrials.gov: NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.
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Affiliation(s)
- Matthew Hickman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - John F Dillon
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Daniela De Angelis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Graham Foster
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | | | | | - David Goldberg
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | | | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | | | - Sema Mandal
- National Infection Service, Public Health England, London, UK
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, UK
| | - Lewis J Z Beer
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Kate Drysdale
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Rachel Glass
- National Infection Service, Public Health England, London, UK
| | | | - Rory N Gunson
- West Of Scotland Specialist Virology Centre, NHS Greater Glasgow & Clyde Board, Glasgow, UK
| | | | - Helen Harris
- National Infection Service, Public Health England, London, UK
| | | | - Ross Harris
- National Infection Service, Public Health England, London, UK
| | | | - Vivian Hope
- Liverpool John Moores University, Liverpool, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Sarah Karen Inglis
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Hamish Innes
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Jade Meadows
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | | | - Gareth Myring
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Norah E Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Anne Presanis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Radley
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Mary Ramsay
- National Infection Service, Public Health England, London, UK
| | - Pantelis Samartsidis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Simmons
- National Infection Service, Public Health England, London, UK
| | - Katy Sinka
- National Infection Service, Public Health England, London, UK
| | | | - Zoe Ward
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | - Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
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10
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Ireland G, Simmons R, Hickman M, Eastwood B, Ramsay M, Mandal S. Mapping the hepatitis C cascade of care in people attending drug treatment services in England: A data linkage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:55-60. [PMID: 31257040 DOI: 10.1016/j.drugpo.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Hepatitis C (HCV) infection in England primarily affects people who inject drugs (PWID). We describe persons HCV tested, estimate incidence and establish the cascade of care (CoC) for people engaging with drug services. METHODS Persons testing for HCV in drug services in Sentinel Surveillance of Blood Borne Virus Testing (SSBBV) between 2008 and 2016 were linked with people attending drug services in the National Drug and Treatment Monitoring System (NDTMS). We describe risk characteristics, establish the CoC, and estimate HCV incidence in PWID diagnosed in drug services. RESULTS Of 46,721 persons tested for anti-HCV in SSBBV in drug services, 29,773 (63.7%) linked to NDTMS. Of these, 9100 (30.6%) were antiV positive and anti-HCV positivity was 45.0% in persons reporting urgent housing problems and 43.8% in persons reporting ever injecting. Among persons anti-HCV positive, half had ≥1 positive anti-HCV test. For persons' first anti-HCV positive between 2008 and 2013 (n = 3123), 74.9% were HCV RNA tested, of whom 71.2% were RNA positive, and of these, 14.0% had evidence of interferon-based treatment, with 52.8% achieving cure. Among PWID, HCV incidence was 8.7 per 100 person-years (95% CI: 8.1-9.2). CONCLUSION Through record linkage of surveillance datasets, we estimated the HCV CoC for people attending drug services, providing a benchmark from which to monitor the impact of strategies to scale-up prevention, testing, and curative treatment with direct acting antivirals. Our study highlights wasteful repeated testing and poor linkage to care for this high risk population which need to be addressed.
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Affiliation(s)
- G Ireland
- National Infection Service, Public Health England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK.
| | - R Simmons
- National Infection Service, Public Health England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK
| | - M Hickman
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at University of Bristol, UK; Population Health Sciences, Bristol Medical School, UK
| | - B Eastwood
- Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, UK
| | - M Ramsay
- National Infection Service, Public Health England, UK
| | - S Mandal
- National Infection Service, Public Health England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK
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11
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Steba GS, Koekkoek SM, Vanhommerig JW, Brinkman K, Kwa D, Van Der Meer JTM, Prins M, Berkhout B, Tanck M, Paxton WA, Molenkamp R, Schinkel J. DC-SIGN Polymorphisms Associate with Risk of Hepatitis C Virus Infection Among Men who Have Sex with Men but not Among Injecting Drug Users. J Infect Dis 2019; 217:353-357. [PMID: 29140443 PMCID: PMC5853896 DOI: 10.1093/infdis/jix587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/10/2017] [Indexed: 12/16/2022] Open
Abstract
We aimed to identify whether genetic polymorphisms within L-SIGN or DC-SIGN correlate with hepatitis C virus (HCV) susceptibility. A men who have sex with men (MSM) and an injecting drug users (IDU) cohort of HCV cases and multiple-exposed uninfected controls were genotyped for numerous L-SIGN and DC-SIGN polymorphisms. DC-SIGN single nucleotide polymorphisms (SNPs) -139, -871, and -939 correlated with HCV acquisition in the MSM cohort only. When the same SNPs were introduced into a transcription activity assay they demonstrated a reduction in expression with predicted alteration in binding of transcription factors. DC-SIGN promoter SNPs correlated with risk of HCV acquisition via sexual but not IDU exposure, likely through modulation of mRNA expression levels.
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Affiliation(s)
- Gaby S Steba
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Sylvie M Koekkoek
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost W Vanhommerig
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Amsterdam, The Netherlands
| | - David Kwa
- Department of Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jan T M Van Der Meer
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine, and AIDS, Center for Infection and Immunity Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ben Berkhout
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Michael Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - William A Paxton
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, UK
| | - Richard Molenkamp
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
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12
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Steba GS, Koekkoek SM, Tanck MWT, Vanhommerig JW, van der Meer JTM, Kwa D, Brinkman K, Prins M, Berkhout B, Pollakis G, Molenkamp R, Schinkel J, Paxton WA, the MOSAIC (MSM observational Study of Acute infection with Hepatitis C) Study Group and the ACS (Amsterdam Cohort Studies). SNP rs688 within the low-density lipoprotein receptor (LDL-R) gene associates with HCV susceptibility. Liver Int 2019; 39:463-469. [PMID: 30260075 PMCID: PMC6588020 DOI: 10.1111/liv.13978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Despite high-risk behaviour, 10%-20% of HCV multiple exposed individuals remain uninfected (MEU), whilst the remainder become infected (MEI). We hypothesize that host factors play a role in HCV susceptibility. We aimed to identify polymorphisms in host genes that encode for proteins involved in viral entry: CD81, Scavenger receptor 1 (SR-1), Low-density lipoprotein receptor (LDL-R), Claudin-1 (CLDN1), Occludin (OCLN) and Niemann-Pick C1-like 1 (NPC1L1). METHODS Multiple exposed infected and MEU from two observational cohorts were selected. From the MSM study of acute infection with HCV (MOSAIC), HIV-1 infected MEU cases (n = 30) and HIV-1 infected MEI controls (n = 32) were selected based on reported high-risk behaviour. From the Amsterdam Cohorts Studies (ACS) injecting drug users (IDU) cohort, MEU cases (n = 40) and MEI controls (n = 22) were selected who injected drugs for ≥2 years, in the nineties, when HCV incidence was high. Selected single nucleotide polymorphisms (SNPs) were determined by sequencing or SNP assays. RESULTS No associations were found for SNPs within genes coding for CD81, SR-1, Claudin-1 or Occludin between the MEU and MEI individuals from either cohort. We did observe a significant association for rs688 within the LDL-R gene with HCV infection (OR: 0.41 P = 0.001), however, LDL cholesterol levels did not vary between individuals carrying the differential SNPs. Additionally, a marginal significant effect was found for rs217434 and rs2072183 (OR: 2.07 P = 0.032 and OR: 1.76 P = 0.039, respectively) within NPC1L1. CONCLUSIONS Our results demonstrate that the rs688 SNP within the LDL-R gene associates with HCV susceptibility through mucosal as well as intravenous exposure.
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Affiliation(s)
- Gaby S. Steba
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sylvie M. Koekkoek
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Michael W. T. Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics (CEBB), Amsterdam UMCAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Joost W. Vanhommerig
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands,Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
| | - Jan T. M. van der Meer
- Division of Infectious Diseases, Tropical Medicine and AIDS, Department of Internal Medicine, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - David Kwa
- Department of MicrobiologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Kees Brinkman
- Department of Internal MedicineOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Maria Prins
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands,Department of Clinical Epidemiology, Biostatistics and Bioinformatics (CEBB), Amsterdam UMCAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Ben Berkhout
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Georgios Pollakis
- Department of Clinical Infection, Microbiology and ImmunologyInstitute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
| | - Richard Molenkamp
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - William A. Paxton
- Department of Medical Microbiology, Amsterdam UMC, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands,Department of Clinical Infection, Microbiology and ImmunologyInstitute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
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13
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Modin L, Arshad A, Wilkes B, Benselin J, Lloyd C, Irving WL, Kelly DA. Epidemiology and natural history of hepatitis C virus infection among children and young people. J Hepatol 2019; 70:371-378. [PMID: 30496763 DOI: 10.1016/j.jhep.2018.11.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/16/2018] [Accepted: 11/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Chronic hepatitis C virus (HCV) infection is a global health burden. Although HCV infection rarely contributes to morbidity during childhood, most HCV-infected children develop chronic HCV with a lifetime risk of liver disease. Little is known about the development of long-term liver disease and the effect of treatment in patients infected with HCV in childhood. METHOD This study was a retrospective review of patients infected with HCV in childhood enrolled in HCV Research UK. A total of 1,049 patients were identified and included. RESULTS The main routes of infection were intravenous drug use (53%), blood product exposure (24%) and perinatal infection (11%). Liver disease developed in 32% of patients, a median of 33 years after infection, irrespective of the mode of infection. Therefore, patients with perinatal exposure developed cirrhosis at an earlier age than the rest of the risk groups. The incidence of hepatocellular carcinoma (HCC) was 5%, liver transplant 4% and death occurred in 3%. Overall, 663 patients were treated (55% with interferon/pegylated interferon and 40% with direct-acting antivirals). Sustained virological response (SVR) was achieved in 406 (75%). There was a higher mortality rate among patients without SVR vs. those with SVR (5% vs. 1%, p = 0.003). Treatment was more effective in patients without cirrhosis and disease progression was less frequent (13%) than in patients with cirrhosis at the time of therapy (28%) p < 0.001. Patients with cirrhosis were more likely to develop HCC, require liver transplantation, or die. CONCLUSION HCV infection in young people causes significant liver disease, which can now be prevented with antiviral therapy. Early treatment, especially before development of cirrhosis is essential. Detection of HCV should be aimed at relevant risk groups and antiviral therapy should be made available in childhood to prevent long-term liver disease and spread of HCV. LAY SUMMARY Chronic hepatitis C virus (HCV) infection is a global health problem, which can now be treated with potent direct-acting antiviral drugs. This study demonstrates that HCV infection in childhood causes serious liver disease in 32% of patients, a median of 33 years after infection, irrespective of age, mode and route of infection. Disease outcomes were better in patients treated before the development of advanced liver disease. Antiviral therapy should be made available in childhood to prevent long-term liver disease and the spread of HCV.
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Affiliation(s)
- Line Modin
- Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK.
| | - Adam Arshad
- Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - Bryony Wilkes
- Gastrointestinal and Liver Disorders Team, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospital NHS Trust and the University of Nottingham, UK
| | - Jennifer Benselin
- Gastrointestinal and Liver Disorders Team, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospital NHS Trust and the University of Nottingham, UK
| | - Carla Lloyd
- Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
| | - William L Irving
- Gastrointestinal and Liver Disorders Team, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospital NHS Trust and the University of Nottingham, UK
| | - Deirdre A Kelly
- Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK
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14
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Mabileau G, Dhersin JS, Yazdanpanah Y. Effectiveness and cost-effectiveness of interventions targeting harm reduction and chronic hepatitis C cascade of care in people who inject drugs: The case of France. J Viral Hepat 2018; 25:1197-1207. [PMID: 29660211 DOI: 10.1111/jvh.12919] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/06/2018] [Indexed: 12/30/2022]
Abstract
Direct-acting antivirals (DAAs) represent an opportunity to improve hepatitis C virus (HCV) care cascade. This combined with improved harm reduction interventions may lead to HCV elimination especially in people who inject drugs (PWID). We assessed the effectiveness/cost-effectiveness of improvements in harm reduction and chronic hepatitis C (CHC) care cascade in PWID in France. We used a dynamic model of HCV transmission and CHC natural history and evaluated the following: improved needle/syringe programmes-opioid substitution therapies, faster diagnosis/linkage to care, earlier treatment initiation, alone and in combination among active PWID (mean age = 36). Outcomes were as follows: life expectancy in discounted quality-adjusted life years (QALYs); direct lifetime discounted costs; incremental cost-effectiveness ratio (ICER); number of infections/reinfections. Under the current practice, life expectancy was 15.846 QALYs, for a mean lifetime cost of €20 762. Treatment initiation at F0 fibrosis stage alone was less effective and more costly than faster diagnosis/linkage to care combined with treatment initiation at F0, which increased life expectancy to 16.694 QALYs, decreased new infections by 37%, with a ICER = €5300/QALY. Combining these interventions with harm reduction improvements was the most effective scenario (life expectancy = 16.701 QALYs, 41% decrease in new infections) but was not cost-effective (ICER = €105 600/QALY); it became cost-effective with higher initial HCV incidence rates and lower harm reduction coverage than in our base-case scenario. This study illustrated the high effectiveness, and cost-effectiveness, of a faster diagnosis/linkage to care together with treatment from F0 with DAAs. This "Test and treat" strategy should play a central role both in improving the life expectancies of HCV-infected patients, and in reducing HCV transmission.
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Affiliation(s)
- A Cousien
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - V C Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq Cedex, France
| | - S Deuffic-Burban
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,Inserm, LIRIC-UMR995, Univ Lille, Lille, France
| | - M Jauffret-Roustide
- CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, (INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, France.,Institut de Veille Sanitaire, Saint-Maurice, France
| | - G Mabileau
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - J-S Dhersin
- LAGA, CNRS, UMR 7539, Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France
| | - Y Yazdanpanah
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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15
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Ward Z, Platt L, Sweeney S, Hope VD, Maher L, Hutchinson S, Palmateer N, Smith J, Craine N, Taylor A, Martin N, Ayres R, Dillon J, Hickman M, Vickerman P. Impact of current and scaled-up levels of hepatitis C prevention and treatment interventions for people who inject drugs in three UK settings-what is required to achieve the WHO's HCV elimination targets? Addiction 2018; 113:1727-1738. [PMID: 29774607 PMCID: PMC6175066 DOI: 10.1111/add.14217] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/15/2017] [Accepted: 03/05/2018] [Indexed: 12/24/2022]
Abstract
AIMS To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three UK settings and to determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organization (WHO) target of reducing HCV incidence by 90% by 2030. DESIGN HCV transmission modelling using UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition. SETTING AND PARTICIPANTS Three UK cities with varying chronic HCV prevalence (Bristol 45%, Dundee 26%, Walsall 19%), OST (72-81%) and HCNSP coverage (28-56%). MEASUREMENTS Relative change in new HCV infections throughout 2016-30 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target. FINDINGS Removing HCNSP or OST would increase the number of new HCV infections throughout 2016 to 2030 by 23-64 and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29 or 49% reduction in Bristol and Walsall, respectively, whereas Dundee may achieve a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently two and nine treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up. CONCLUSIONS Current opioid substitution therapy and high-coverage needle and syringe provision coverage is averting substantial hepatitis C transmission in the United Kingdom. Maintaining this coverage while getting current drug injectors onto treatment can reduce incidence by 90% by 2030.
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Affiliation(s)
- Zoe Ward
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
| | - Lucy Platt
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sedona Sweeney
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Vivian D. Hope
- Public Health EnglandUK
- Public Health Institute, Liverpool John Moores UniversityLiverpoolUK
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSWAustralia
| | - Sharon Hutchinson
- Health and Life SciencesGlasgow Caledonian UniversityUK
- Blood‐borne Viruses and Sexually Transmitted Infections SectionHealth Protection ScotlandUK
| | - Norah Palmateer
- Health and Life SciencesGlasgow Caledonian UniversityUK
- Blood‐borne Viruses and Sexually Transmitted Infections SectionHealth Protection ScotlandUK
| | - Josie Smith
- Substance Misuse ‐ Drugs and AlcoholPublic Health WalesUK
| | - Noel Craine
- Substance Misuse ‐ Drugs and AlcoholPublic Health WalesUK
| | - Avril Taylor
- School of Media, Society and CultureUniversity of West of ScotlandUK
| | - Natasha Martin
- Department of MedicineUniversity of California, San DiegoUSA
| | | | | | - Matthew Hickman
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
| | - Peter Vickerman
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
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16
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Platt L, Sweeney S, Ward Z, Guinness L, Hickman M, Hope V, Hutchinson S, Maher L, Iversen J, Craine N, Taylor A, Munro A, Parry J, Smith J, Vickerman P. Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background
There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations.
Objective(s)
To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission.
Design
We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision.
Setting
Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international.
Participants
PWID.
Interventions
NSP coverage (proportion of injections covered by clean needles) and OST.
Outcome
New cases of HCV infection.
Results
The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years.
Limitations
Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this.
Conclusions
There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings.
Future work
To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation.
Funding
The National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sedona Sweeney
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Zoe Ward
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lorna Guinness
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivian Hope
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lisa Maher
- Viral Hepatitis Epidemiology and Prevention Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Iversen
- Viral Hepatitis Epidemiology and Prevention Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Noel Craine
- Health Protection Division, Public Health Wales, Cardiff, UK
| | - Avril Taylor
- School of Media Society and Culture, University of the West of Scotland, Paisley, UK
| | - Alison Munro
- School of Social Science, University of the West of Scotland, Paisley, UK
| | - John Parry
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Josie Smith
- Health Protection Division, Public Health Wales, Cardiff, UK
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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17
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Cousien A, Leclerc P, Morissette C, Bruneau J, Roy É, Tran VC, Yazdanpanah Y, Cox J. The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study. BMC Infect Dis 2017; 17:162. [PMID: 28222681 PMCID: PMC5320702 DOI: 10.1186/s12879-017-2256-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/08/2017] [Indexed: 01/02/2023] Open
Abstract
Background HCV transmission remains high in people who inject drugs (PWID) in Montréal. New direct-acting antivirals (DAAs), highly effective and more tolerable than previous regimens, make a “Treatment as Prevention” (TasP) strategy more feasible. This study assesses how improvements in the cascade of care could impact hepatitis C burden among PWID in Montréal. Methods We used a dynamic model to simulate HCV incidence and prevalence after 10 years, and cirrhosis complications after 10 and 40 years. Eight scenarios of improved cascade of care were examined. Results Using a baseline incidence and prevalence of 22.1/100 person-years (PY) and 53.1%, implementing the current cascade of care using DAAs would lead to HCV incidence and prevalence estimates at 10 years of 9.4/100PY and 55.8%, respectively. Increasing the treatment initiation rate from 5%/year initially to 20%/year resulted in large decreases in incidence (6.4/100PY), prevalence (36.6%), and cirrhosis complications (−18%/-37% after 10/40 years). When restricting treatment to fibrosis level ≥ F2 instead of F0 (reference scenario), such decreases in HCV occurrence were unreachable. Improving the whole cascade of care led to the greatest effect by halving both the incidence and prevalence at 10 years, and the number of cirrhosis complications after 40 years. Conclusions The current level of treatment access in Montréal is limiting a massive decrease in hepatitis C burden among PWID. A substantial treatment scale-up, regardless of fibrosis level, is necessary. While improving the rest of the cascade of care is necessary to optimize a TasP strategy and control the HCV epidemic, a treatment scale-up is first needed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2256-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.,Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada
| | - Pascale Leclerc
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada
| | - Carole Morissette
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada
| | - Julie Bruneau
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, H2X 0A9, Canada
| | - Élise Roy
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Campus Longueuil, 150 place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Viet Chi Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
| | - Joseph Cox
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A3, Canada. .,Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A3J1, Canada.
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18
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Rafia R, Dodd PJ, Brennan A, Meier PS, Hope VD, Ncube F, Byford S, Tie H, Metrebian N, Hellier J, Weaver T, Strang J. An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence. Addiction 2016; 111:1616-27. [PMID: 26990598 PMCID: PMC5347913 DOI: 10.1111/add.13385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/18/2016] [Accepted: 03/10/2016] [Indexed: 12/21/2022]
Abstract
AIMS To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources. DESIGN A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. SETTINGS AND PARTICIPANTS Data on attendance to vaccination from a UK cluster randomized trial. INTERVENTION Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. MEASUREMENT Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. FINDINGS The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). CONCLUSIONS Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%.
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Affiliation(s)
- Rachid Rafia
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Peter J. Dodd
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Alan Brennan
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Petra S. Meier
- Section of Public Health, School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
| | - Vivian D. Hope
- Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and ControlPublic Health UK (PHE)LondonUK
| | - Fortune Ncube
- Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and ControlPublic Health UK (PHE)LondonUK
| | - Sarah Byford
- Centre for the Economics of Mental and Physical HealthKing's College LondonLondonUK
| | - Hiong Tie
- Centre for the Economics of Mental and Physical HealthKing's College LondonLondonUK
| | - Nicola Metrebian
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Tim Weaver
- Department of Mental Health, Social Work and Integrative MedicineMiddlesex UniversityHendonUK
| | - John Strang
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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19
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Harris RJ, Martin NK, Rand E, Mandal S, Mutimer D, Vickerman P, Ramsay ME, De Angelis D, Hickman M, Harris HE. New treatments for hepatitis C virus (HCV): scope for preventing liver disease and HCV transmission in England. J Viral Hepat 2016; 23:631-43. [PMID: 27025238 PMCID: PMC4982023 DOI: 10.1111/jvh.12529] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/28/2016] [Indexed: 12/30/2022]
Abstract
New direct-acting antivirals have the potential to transform the hepatitis C (HCV) treatment landscape, with rates of sustained viral response in excess of 90%. As these new agents are expensive, an important question is whether to focus on minimizing the consequences of severe liver disease, or reducing transmission via 'treatment as prevention'. A back-calculation model was used to estimate the impact of treatment of mild, moderate and compensated cirrhosis on incident cases of HCV-related end-stage liver disease/hepatocellular carcinoma (ESLD/HCC). In addition, a dynamic model was used to determine the impact on incidence and prevalence of chronic infection in people who inject drugs (PWID), the main risk group in England. Treating 3500 cirrhotics per year was predicted to reduce ESLD/HCC incidence from 1100 (95% CrI 970-1240) cases per year in 2015 to 630 (95% CrI 530-770) in 2020, around half that currently expected, although treating moderate-stage disease will also be needed to sustain this reduction. Treating mild-stage PWID was required to make a substantial impact on transmission: with 2500 treated per year, chronic prevalence/annual incidence in PWID was reduced from 34%/4.8% in 2015 to 11%/1.4% in 2030. There was little overlap between the two goals: treating mild stage had virtually no impact on ESLD/HCC within 15 years, but the long timescale of liver disease means relatively few PWID reach cirrhosis before cessation of injecting. Strategies focussing on treating advanced disease have the potential for dramatic reductions in severe morbidity, but virtually no preventative impact.
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Affiliation(s)
- R J Harris
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - N K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Rand
- University of Pennsylvania, Philadelphia, PA, USA
| | - S Mandal
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, UK
| | - D Mutimer
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
- National Institute for Health, Research Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - P Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - M E Ramsay
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, UK
| | - D De Angelis
- Statistics, Modelling and Economics Department, Public Health England, London, UK
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H E Harris
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, UK
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20
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS, Yazdanpanah Y. Hepatitis C treatment as prevention of viral transmission and liver-related morbidity in persons who inject drugs. Hepatology 2016; 63:1090-101. [PMID: 26390137 DOI: 10.1002/hep.28227] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/13/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED Hepatitis C virus (HCV) seroprevalence remains high in people who inject drug (PWID) populations, often above 60%. Highly effective direct-acting antiviral (DAA) regimens (90% efficacy) are becoming available for HCV treatment. This therapeutic revolution raises the possibility of eliminating HCV from this population. However, for this, an effective cascade of care is required. In the context of the available DAA therapies, we used a dynamic individual-based model including a model of the PWID social network to simulate the impact of improved testing, linkage to care, and adherence to treatment, and of modified treatment recommendation on the transmission and on the morbidity of HCV in PWID in France. Under the current incidence and cascade of care, with treatment initiated at fibrosis stage ≥F2, HCV prevalence decreased from 42.8% to 24.9% (95% confidence interval: 24.8-24.9) after 10 years. Changing treatment initiation criteria to treat from F0 was the only intervention leading to a substantial additional decrease in prevalence, which fell to 11.6% (95% CI: 11.6-11.7) at 10 years. Combining this change with improved testing, linkage to care, and adherence to treatment decreased HCV prevalence to 7.0% (95% CI: 7.0-7.1) at 10 years and avoided 15% (95% CI: 14-17) and 29% (95% CI: 28-30) of cirrhosis complications over 10 and 40 years, respectively. CONCLUSIONS Major decreases in prevalent HCV infections occur only when treatment is initiated at early stages of fibrosis, suggesting that systematic treatment in PWID, where incidence remains high, would be beneficial. However, elimination within the 10 next years will be difficult to achieve using treatment alone, even with a highly improved cascade of care.
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Viet Chi Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq, France
| | - Sylvie Deuffic-Burban
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Inserm, LIRIC-UMR995, Lille, France, Université Lille, Lille, France
| | - Marie Jauffret-Roustide
- CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, (INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, France.,Institut de Veille Sanitaire, Saint-Maurice, France
| | - Jean-Stéphane Dhersin
- Université Paris 13, Sorbonne Paris Cité, LAGA, CNRS, UMR 7539, Villetaneuse, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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21
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Komatsu H, Inui A, Fujisawa T. The Role of Body Fluids in the Horizontal Transmission of Hepatitis B Virus via Household/Close Contact. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10311375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Hepatitis B virus (HBV) infection commonly occurs through horizontal transmission via household/close contact. Although the body fluids of patients infected with HBV are likely to play a significant role in horizontal transmission, the precise mechanism remains unclear. In the 1970s, the infectivity of body fluids including saliva, urine, and faeces was assessed for the presence of hepatitis B surface antigen (HBsAg). Over the last decade, the HBV DNA in the body fluids of chronically infected patients was quantified using real-time polymerase chain reaction. Chimpanzee, gibbon, and chimeric mice with human livers have also been used to investigate the infectivity of body fluids. HBsAg levels, HBV DNA levels, and animal experiments have indicated that saliva and tears are able to transmit HBV. Urine and faeces do not lead to horizontal transmission. The infectivity of the remaining body fluids remains controversial. Horizontal transmission is related to both virus and host factors; thus, evaluations of HBsAg and HBV DNA levels provide insufficient data to determine the infectivity of body fluids. Universal hepatitis B vaccination has been implemented worldwide (with the exception of Northern Europe); an understanding of the role that body fluids play in horizontal transmission will contribute to the eradication of HBV.
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Affiliation(s)
- Haruki Komatsu
- Department of Pediatrics, Toho University Sakura Medical Center, Chiba, Japan
| | - Ayano Inui
- Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan
| | - Tomoo Fujisawa
- Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan
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22
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Malekinejad M, Navadeh S, Lotfizadeh A, Rahimi-Movaghar A, Amin-Esmaeili M, Noroozi A. High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001-2012). Int J Infect Dis 2015; 40:116-30. [PMID: 26460088 PMCID: PMC8741151 DOI: 10.1016/j.ijid.2015.09.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Drug users, particularly drug injectors, are at elevated risk of blood-borne diseases. This study systematically reviewed the prevalence of hepatitis C virus (HCV) mono-infection and its co-infections with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in drug users in Iran. METHODS Searches were conducted in international, regional, and Iranian databases. Documents were screened, data extracted, and pooled point prevalence and 95% confidence intervals (CI) were calculated. RESULTS Overall, 13,821 subjects (87.4% male) with an average age of 32.4 years (95% CI 31-33 years) from 24 original studies were included in the analysis. The pooled HCV prevalence (95% CI) among drug users with and without an injection history was 45% (37-54%) and 8% (4-13%), respectively. The pooled HCV prevalences (95% CI) among individuals with vs. without a history of imprisonment and needle sharing were 58% (39-77%) vs. 44% (20-68%) and 56% (41-71%) vs. 49% (26-71%), respectively. The prevalence of HCV/HIV co-infection among injectors was 11% (95% CI 5-16%). CONCLUSIONS HCV prevalence is high in drug users in Iran, especially among those with a history of injection drug use, needle sharing, and imprisonment. Drug user-focused HCV prevention and treatment programs are urgently needed.
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Affiliation(s)
- Mohsen Malekinejad
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA; Global Health Sciences, University of California, 3333 California Street, Suite 265, San Francisco, CA 94118, USA.
| | - Soodabeh Navadeh
- Global Health Sciences, University of California, 3333 California Street, Suite 265, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Lotfizadeh
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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23
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Rodríguez-Barraquer I, Solomon SS, Kuganantham P, Srikrishnan AK, Vasudevan CK, Iqbal SH, Balakrishnan P, Solomon S, Mehta SH, Cummings DAT. The Hidden Burden of Dengue and Chikungunya in Chennai, India. PLoS Negl Trop Dis 2015; 9:e0003906. [PMID: 26181441 PMCID: PMC4504702 DOI: 10.1371/journal.pntd.0003906] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 06/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background Dengue and chikungunya are rapidly expanding viruses transmitted by mosquitoes of the genus Aedes. Few epidemiological studies have examined the extent of transmission of these infections in South India despite an increase in the number of reported cases, and a high suitability for transmission. Methods and findings We conducted a household-based seroprevalence survey among 1010 individuals aged 5-40 years living in fifty randomly selected spatial locations in Chennai, Tamil Nadu. Participants were asked to provide a venous blood sample and to complete a brief questionnaire with basic demographic and daily activity information. Previous exposure to dengue and chikungunya was determined using IgG indirect ELISA (Panbio) and IgG ELISA (Novatec), respectively. We used this data to estimate key transmission parameters (force of infection and basic reproductive number) and to explore factors associated with seropositivity. While only 1% of participants reported history of dengue and 20% of chikungunya, we found that 93% (95%CI 89-95%) of participants were seropositive to dengue virus, and 44% (95%CI 37-50%) to chikungunya. Age-specific seroprevalence was consistent with long-tem, endemic circulation of dengue and suggestive of epidemic chikungunya transmission. Seropositivity to dengue and chikungunya were significantly correlated, even after adjusting for individual and household factors. We estimate that 23% of the susceptible population gets infected by dengue each year, corresponding to approximately 228,000 infections. This transmission intensity is significantly higher than that estimated in known hyperendemic settings in Southeast Asia and the Americas. Conclusions These results provide unprecedented insight into the very high transmission potential of dengue and chikungunya in Chennai and underscore the need for enhanced surveillance and control methods. Despite a recent increase in the number of cases, little data exist on the extent of dengue and chikungunya transmission in Indian cities. We conducted a household-based serosurvey conducted in randomly selected spatial locations across the metropolis of Chennai. We tested samples for evidence of previous infection by dengue and chikungunya viruses and used this data to estimate key transmission parameters (force of infection and basic reproductive number) and to explore factors associated with seropositivity. We found that 93% of participants had been exposed to dengue virus, and 44% to chikungunya. We estimate that 23% of the susceptible population gets infected by dengue virus each year, corresponding to approximately 228,000 infections per year. This transmission intensity is almost three times larger than that in traditionally hyperendemic district in Thailand, and suggests an extremely large proportion of asymptomatic/sub-clinical disease, a lack of recognition of the disease and/or under-reporting.
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Affiliation(s)
| | - Sunil S. Solomon
- Johns Hopkins University, Baltimore, Maryland, United States of America
- YRGCARE, Chennai, India
| | | | | | | | | | | | | | - Shruti H. Mehta
- Johns Hopkins University, Baltimore, Maryland, United States of America
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS, Yazdanpanah Y. Dynamic modelling of hepatitis C virus transmission among people who inject drugs: a methodological review. J Viral Hepat 2015; 22:213-29. [PMID: 25270261 DOI: 10.1111/jvh.12337] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/25/2014] [Indexed: 12/09/2022]
Abstract
Equipment sharing among people who inject drugs (PWID) is a key risk factor in infection by hepatitis C virus (HCV). Both the effectiveness and cost-effectiveness of interventions aimed at reducing HCV transmission in this population (such as opioid substitution therapy, needle exchange programmes or improved treatment) are difficult to evaluate using field surveys. Ethical issues and complicated access to the PWID population make it difficult to gather epidemiological data. In this context, mathematical modelling of HCV transmission is a useful alternative for comparing the cost and effectiveness of various interventions. Several models have been developed in the past few years. They are often based on strong hypotheses concerning the population structure. This review presents compartmental and individual-based models to underline their strengths and limits in the context of HCV infection among PWID. The final section discusses the main results of the papers.
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Affiliation(s)
- A Cousien
- IAME, UMR 1137, INSERM, Paris, France; IAME, UMR 1137, Sorbonne Paris Cité, Univ Paris Diderot, Paris, France
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Nazari F, Gumel AB, Elbasha EH. Differential characteristics of primary infection and re-infection can cause backward bifurcation in HCV transmission dynamics. Math Biosci 2015; 263:51-69. [PMID: 25686692 DOI: 10.1016/j.mbs.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 02/06/2023]
Abstract
Backward bifurcation, a phenomenon typically characterized by the co-existence of multiple stable equilibria when the associated reproduction number of the model is less than unity, has been observed in numerous disease transmission models. This study establishes, for the first time, the presence of this phenomenon in the transmission dynamics of hepatitis C virus (HCV) within an IDU population. It is shown that the phenomenon does not exist under four scenarios, namely (i) in the absence of re-infection, (ii) in the absence of differential characteristics of HCV infection (with respect to infectivity, progression, treatment and recovery) between re-infected individuals and primary-infected individuals, (iii) when re-infected and treated individuals do not transmit HCV infection and (iv) when the average infectivity-adjusted duration of re-infection is less than that of primary infection. This study identifies, using sensitivity analysis, five parameters of the model that have the most influence on the disease transmission dynamics, namely: effective contact rate, progression rate from acute to chronic infection, recovery rate from acute infection, natural death rate and the relative infectiousness of chronically-infected individuals. Numerical simulations of the model show that the re-infection of recovered individuals has marginal effect on the HCV burden (as measured in terms of the cumulative incidence and the prevalence of the disease) in the IDU community. Furthermore, treatment of infected IDUs, even for small rate (such as 4%), offers significant impact on curtailing HCV spread in the community.
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Affiliation(s)
- F Nazari
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ 85287-1904, USA
| | - A B Gumel
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ 85287-1904, USA; School of Mathematical and Natural Sciences, Arizona State University, Phoenix, AZ 85069-7100, USA.
| | - E H Elbasha
- Merk Research Laboratories, UG1C-60, P.O. Box 1000, North Wales, PA 19454-1099, USA
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Increased uptake and new therapies are needed to avert rising hepatitis C-related end stage liver disease in England: modelling the predicted impact of treatment under different scenarios. J Hepatol 2014; 61:530-7. [PMID: 24824282 DOI: 10.1016/j.jhep.2014.05.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 02/28/2014] [Accepted: 05/03/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Hepatitis C (HCV) related disease in England is predicted to rise, and it is unclear whether treatment at current levels will be able to avert this. The aim of this study was to estimate the number of people with chronic HCV infection in England that are treated and assess the impact and costs of increasing treatment uptake. METHODS Numbers treated were estimated using national data sources for pegylated interferon supplied, dispensed, or purchased from 2006 to 2011. A back-calculation approach was used to project disease burden over the next 30 years and determine outcomes under various scenarios of treatment uptake. RESULTS 5000 patients were estimated to have been treated in 2011 and 28,000 in total from 2006 to 2011; approximately 3.1% and 17% respectively of estimated chronic infections. Without treatment, incident cases of decompensated cirrhosis and hepatocellular carcinoma were predicted to increase until 2035 and reach 2290 cases per year. Treatment at current levels should reduce incidence by 600 cases per year, with a peak around 2030. Large increases in treatment are needed to halt the rise; and with more effective treatment the best case scenario predicts incidence of around 500 cases in 2030, although treatment uptake must still be increased considerably to achieve this. CONCLUSIONS If the infected population is left untreated, the number of patients with severe HCV-related disease will continue to increase and represent a substantial future burden on healthcare resources. This can be mitigated by increasing treatment uptake, which will have the greatest impact if implemented quickly.
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Sugden PB, Cameron B, Luciani F, Lloyd AR. Exploration of genetically determined resistance against hepatitis C infection in high-risk injecting drug users. J Viral Hepat 2014; 21:e65-73. [PMID: 24612442 DOI: 10.1111/jvh.12232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/12/2014] [Indexed: 01/08/2023]
Abstract
Genetic resistance to specific infections is well recognized. In hepatitis C virus (HCV) infection, genetic polymorphisms in IL-28B and the killer cell immunoglobulin-like receptors (KIR) and their HLA class I ligands have been shown to affect clearance of the virus following infection. There are limited data regarding resistance to established HCV infection. Reliable quantification of repeated exposure in high-risk populations, such as injecting drug users (IDU), is a key limitation of previous studies of resistance. Behavioural data and DNA from IDU (n = 210) in the Hepatitis C Incidence and Transmission Study in prisons (HITS-p) cohort were genotyped for polymorphisms in: IL-28B, peptidyl-prolyl isomerase A (PPIA), HLA-C and KIR2. To quantify risk, a composite risk index based on factors predictive of incident HCV infection was derived. Logistic regression analysis revealed the risk index was strongly associated with incident HCV infection (P < 0.0001). The upper tertile of the uninfected individuals had risk indices comparable to the incident cases, but remained uninfected. There were no significant differences in the frequencies of IL-28B or PPIA polymorphisms between these exposed-uninfected cases, or in the frequencies of KIR2-DL3, HLA-C1, or their combination. A framework for the investigation of genetic determinants of resistance to HCV infection has been developed. Several candidate gene associations were investigated and excluded. Further investigation of genetic determinants of resistance to HCV infection is warranted.
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Affiliation(s)
- P B Sugden
- Inflammation and Infection Research Centre, School of Medical Sciences University of New South Wales, Sydney, NSW, Australia
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Linas BP, Barter DM, Leff JA, Assoumou SA, Salomon JA, Weinstein MC, Kim AY, Schackman BR. The hepatitis C cascade of care: identifying priorities to improve clinical outcomes. PLoS One 2014; 9:e97317. [PMID: 24842841 PMCID: PMC4026319 DOI: 10.1371/journal.pone.0097317] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/17/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. METHODS We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. MAIN MEASURES Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). RESULTS We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. CONCLUSIONS We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and evaluating interventions addressing multiple points along the cascade rather than options focusing solely on single points.
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Affiliation(s)
- Benjamin P. Linas
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Devra M. Barter
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Jared A. Leff
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States of America
| | - Sabrina A. Assoumou
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Joshua A. Salomon
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Milton C. Weinstein
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Arthur Y. Kim
- Massachusetts General Hospital Boston, Massachusetts, United States of America
| | - Bruce R. Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States of America
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Hope VD, Harris RJ, De Angelis D, Croxford S, Marongiu A, Parry JV, Ncube F. Two decades of successes and failures in controlling the transmission of HIV through injecting drug use in England and Wales, 1990 to 2011. ACTA ACUST UNITED AC 2014; 19. [PMID: 24739984 DOI: 10.2807/1560-7917.es2014.19.14.20762] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Responses to injecting drug use have changed focus over the last 20 years. Prevalence and incidence of human immunodeficiency virus (HIV) among people who inject drugs (PWID) in England and Wales were examined in relation to these changes. A voluntary unlinked-anonymous surveillance study obtained a biological sample and questionnaire data from PWID through annual surveys since 1990. Prevalence and incidence trends were estimated via generalised linear models, and compared with a policy time-line. Overall HIV prevalence among 38,539 participations was 1.15%. Prevalence was highest among those who started injecting before 1985; throughout the 1990s, prevalence fell in this group and was stable among those who started injecting later. Prevalence was higher in 2005 than 2000 (odds ratio: 3.56 (95% confidence interval (CI) 1.40–9.03) in London, 3.40 (95% CI 2.31–5.02) elsewhere). Estimated HIV incidence peaked twice, around 1983 and 2005. HIV was an important focus of policy concerning PWID from 1984 until 1998. This focus shifted at a time when drug use and risk were changing. The increased incidence in 2005 cannot be ascribed to the policy changes, but these appeared to be temporally aligned. Policy related to PWID should be continually reviewed to ensure rapid responses to increased risk.
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Affiliation(s)
- V D Hope
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
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Lewis FI, Otero-Abad B, Hegglin D, Deplazes P, Torgerson PR. Dynamics of the force of infection: insights from Echinococcus multilocularis infection in foxes. PLoS Negl Trop Dis 2014; 8:e2731. [PMID: 24651596 PMCID: PMC3961194 DOI: 10.1371/journal.pntd.0002731] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/23/2014] [Indexed: 11/18/2022] Open
Abstract
Characterizing the force of infection (FOI) is an essential part of planning cost effective control strategies for zoonotic diseases. Echinococcus multilocularis is the causative agent of alveolar echinococcosis in humans, a serious disease with a high fatality rate and an increasing global spread. Red foxes are high prevalence hosts of E. multilocularis. Through a mathematical modelling approach, using field data collected from in and around the city of Zurich, Switzerland, we find compelling evidence that the FOI is periodic with highly variable amplitude, and, while this amplitude is similar across habitat types, the mean FOI differs markedly between urban and periurban habitats suggesting a considerable risk differential. The FOI, during an annual cycle, ranges from (0.1,0.8) insults (95% CI) in urban habitat in the summer to (9.4, 9.7) (95% CI) in periurban (rural) habitat in winter. Such large temporal and spatial variations in FOI suggest that control strategies are optimal when tailored to local FOI dynamics. Human alveolar echinococcosis (AE) is caused by the fox tapeworm E. multilocularis and has a high fatality rate if untreated. The frequency of the tapeworm in foxes can be reduced through the regular distribution of anthelmintic baits and thus decrease the risk of zoonotic transmission. Here, we estimate the force of infection to foxes using a mathematical model and data from necropsied foxes. The results suggest that the frequency of anthelmintic baiting of foxes can be optimised to local variations in transmission that depend upon season and type of fox habitat.
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Affiliation(s)
- Fraser I. Lewis
- Section of Veterinary Epidemiology, University of Zürich, Zürich, Switzerland
| | - Belen Otero-Abad
- Section of Veterinary Epidemiology, University of Zürich, Zürich, Switzerland
| | - Daniel Hegglin
- Institute of Parasitology, University of Zürich, Zürich, Switzerland
| | - Peter Deplazes
- Institute of Parasitology, University of Zürich, Zürich, Switzerland
| | - Paul R. Torgerson
- Section of Veterinary Epidemiology, University of Zürich, Zürich, Switzerland
- * E-mail:
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31
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New insights on modeling news dissemination on nuclear issues. PROGRESS IN NUCLEAR ENERGY 2013. [DOI: 10.1016/j.pnucene.2013.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Corson S, Greenhalgh D, Taylor A, Palmateer N, Goldberg D, Hutchinson S. Modelling the prevalence of HCV amongst people who inject drugs: an investigation into the risks associated with injecting paraphernalia sharing. Drug Alcohol Depend 2013; 133:172-9. [PMID: 23791029 DOI: 10.1016/j.drugalcdep.2013.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 05/01/2013] [Accepted: 05/05/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND In order to prevent the spread of the hepatitis C virus (HCV) amongst people who inject drugs (PWID), it is imperative that any injecting risk behaviour which may contribute to the transmission of disease has its role quantified. To inform public health organisations, mathematical modelling techniques were used to explore the risk of HCV infection through the sharing of injecting paraphernalia (including filters, cookers and water). METHODS A mathematical model was developed for the spread of HCV based on the injecting behaviour of PWID in Scotland, with transmission occurring through the sharing of needles/syringes and other injecting paraphernalia. Numerical simulations were used to estimate the transmission probability for HCV through the sharing of injecting paraphernalia such that the modelled endemic HCV prevalence fitted with that observed amongst PWID in Scotland. RESULTS The transmission probability of HCV through injecting paraphernalia was modelled to be over 8 times lower than that through needles/syringes (approximately 0.19-0.30% and 2.5%, respectively), assuming transmission occurs through a combination of at least filters and cookers. In the context of reported needle/syringe and paraphernalia sharing rates in Scotland, it is estimated that 38% and 62% of HCV infections are contributed by these practices, respectively. If needle/syringe sharing rates were to be twice those reported, the contributions would be 70% and 30%, respectively. CONCLUSION Given that the sharing of injecting paraphernalia among PWID is common, HCV transmission through this route could be contributing to the growing healthcare burden associated with this chronic disease. Every effort should therefore be made to establish (a) the contribution that paraphernalia sharing is making to the spread of HCV, and (b) the effectiveness of services providing sterile paraphernalia in preventing infection.
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Affiliation(s)
- Stephen Corson
- Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow G1 1XH, UK.
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Farrington CP, Whitaker HJ, Unkel S, Pebody R. Correlated infections: quantifying individual heterogeneity in the spread of infectious diseases. Am J Epidemiol 2013; 177:474-86. [PMID: 23403987 DOI: 10.1093/aje/kws260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this paper, we propose new methods for investigating the extent of heterogeneity in effective contact rates relevant to the transmission of infections. These methods exploit the correlations between ages at infection for different infections within individuals. The methods are developed for serological surveys, which provide accessible individual data on several infections, and are applied to a wide range of infections. We find that childhood infections are often highly correlated within individuals in early childhood, with the correlations persisting into adulthood only for infections sharing a transmission route. We discuss 2 applications of the methods: 1) to making inferences about routes of transmission when these are unknown or uncertain and 2) to estimating epidemiologic parameters such as the basic reproduction number and the critical immunization threshold. Two examples of such applications are presented: elucidating the transmission route of polyomaviruses BK and JC and estimating the basic reproduction number and critical immunization coverage of varicella-zoster infection in Belgium, Italy, Poland, and England and Wales. We speculate that childhood correlations stem from confounding of different transmission routes and represent heterogeneity in childhood circumstances, notably nursery-school attendance. In contrast, it is suggested that correlations in adulthood are route-specific.
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Affiliation(s)
- C Paddy Farrington
- Department of Mathematics and Statistics, The Open University, Milton Keynes, United Kingdom.
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Castro Sanchez AY, Aerts M, Shkedy Z, Vickerman P, Faggiano F, Salamina G, Hens N. A mathematical model for HIV and hepatitis C co-infection and its assessment from a statistical perspective. Epidemics 2013; 5:56-66. [PMID: 23438431 DOI: 10.1016/j.epidem.2013.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/24/2012] [Accepted: 01/02/2013] [Indexed: 02/05/2023] Open
Abstract
The hepatitis C virus (HCV) and the human immunodeficiency virus (HIV) are a clear threat for public health, with high prevalences especially in high risk groups such as injecting drug users. People with HIV infection who are also infected by HCV suffer from a more rapid progression to HCV-related liver disease and have an increased risk for cirrhosis and liver cancer. Quantifying the impact of HIV and HCV co-infection is therefore of great importance. We propose a new joint mathematical model accounting for co-infection with the two viruses in the context of injecting drug users (IDUs). Statistical concepts and methods are used to assess the model from a statistical perspective, in order to get further insights in: (i) the comparison and selection of optional model components, (ii) the unknown values of the numerous model parameters, (iii) the parameters to which the model is most 'sensitive' and (iv) the combinations or patterns of values in the high-dimensional parameter space which are most supported by the data. Data from a longitudinal study of heroin users in Italy are used to illustrate the application of the proposed joint model and its statistical assessment. The parameters associated with contact rates (sharing syringes) and the transmission rates per syringe-sharing event are shown to play a major role.
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Affiliation(s)
- Amparo Yovanna Castro Sanchez
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Agoralaan 1, B3590 Diepenbeek, Belgium.
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Corson S, Greenhalgh D, Hutchinson SJ. A time since onset of injection model for hepatitis C spread amongst injecting drug users. J Math Biol 2012; 66:935-78. [DOI: 10.1007/s00285-012-0577-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/18/2012] [Indexed: 02/05/2023]
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Estimating the variability in the risk of infection for hepatitis C in the Glasgow injecting drug user population. Epidemiol Infect 2012; 140:2190-8. [PMID: 22459739 DOI: 10.1017/s0950268812000489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Glasgow (Scotland's largest city) has a high prevalence of injecting drug use and has one of the highest prevalences of hepatitis C virus (HCV) infection in injecting drug users (IDUs) in Western Europe. HCV prevalence data from surveys of Glasgow's IDUs from 1990 to 2007 were utilized and a model was applied that described the prevalence of HCV as a function of the rate (force) of infection. Force-of-infection estimates for HCV that may vary over time and injecting career length over a range of variables were investigated. New initiates to injecting were found to be at increased risk of HCV infection, with being recruited from a street location and reporting injecting in prison leading to a significant increase in the risk of infection in new initiates. These results indicate areas of importance for the planning of public health measures that target the IDU population.
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Estimating the force of infection for HCV in injecting drug users using interval-censored data. Epidemiol Infect 2011; 140:1064-74. [DOI: 10.1017/s0950268811001750] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
SUMMARYInjecting drug users (IDUs) account for most new HCV infections. The objectives of this study were: to estimate the force of infection for hepatitis C virus in IDUs within the interval-censoring framework and to determine the impact of risk factors such as frequency of injection, drug injected, sharing of syringes and time of first injection on the time to HCV infection. We used data from the Amsterdam Cohort Study collected in The Netherlands and focused on those individuals who were HCV negative upon entry into the study. Based on the results, the force of infection was found to vary with time of first injection. The risk of infection was higher in the first 3 years of an IDU's career, implying estimates based on single cross-sectional studies could be biased. Frequency of injection and type of drug injected were found to be highly significant predictors, whereas sharing syringes was not.
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Characteristics of HIV epidemics driven by men who have sex with men and people who inject drugs. Curr Opin HIV AIDS 2011; 6:94-101. [PMID: 21505382 DOI: 10.1097/coh.0b013e328343ad93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To highlight the latest developments in mathematical transmission modelling of HIV epidemics among men who have sex with men (MSM) and people who inject drugs (PWID). RECENT FINDINGS Mathematical approaches have been applied to a wide range of topics in recent HIV research. Epidemiological models have evaluated past and forecasted future trends in prevalence and incidence, evaluated innovative behaviour modification strategies and public health programmes aimed at minimizing risk, and explored the potential impact of various biomedical interventions. MSM have developed new risk reduction strategies which models have deemed to be effective at a population level only in certain settings, such as when there are high rates of HIV testing. Modelling has also indicated that persistent circulation of drug-resistant HIV strains is likely to become an inevitable public health issue in the near future in resource-rich settings among MSM. Models have also recently been used to demonstrate that needle and syringe programmes for harm reduction among PWID are effective and cost-effective. SUMMARY Mathematical modelling is particularly amenable to single population groups of concentrated HIV epidemics, such as among MSM and PWID. Models have been utilized to evaluate innovative areas in clinical, biomedical and public health research that cannot be conducted in other population groups. Future directions are likely to include evaluation of specific public health programmes and providing understanding of the importance of specific treatment regimens and incidence and interaction of comorbid conditions associated with HIV.
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Chkhartishvili N, McNutt LA, Smith PF, Tsertsvadze T. Characteristics of HIV-infected women and factors associated with HCV seropositivity in the Republic of Georgia. AIDS Res Ther 2011; 8:25. [PMID: 21787384 PMCID: PMC3154141 DOI: 10.1186/1742-6405-8-25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 07/25/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the extent of the HIV epidemic among women in the Republic of Georgia and to identify factors associated with HCV co-infection in this population. FINDINGS All women aged ≥18 years who were diagnosed with HIV between 1989 and 2006 were identified through the National HIV/AIDS surveillance database. Medical records were reviewed for demographic characteristics, risk factors and HCV serostatus. A total of 249 women were identified. Only 4% declared injection drug use (IDU); sex work was reported by 9%. Substantial risk factors were identified among the women's sexual partners, nearly 69% of whom were IDUs, 84% were HIV positive and 66% HCV positive. Seventeen percent of women were seropositive for HCV. Factors significantly associated with HCV seropositivity in bivariate analyses among non-IDU women were partner IDU+ [Prevalence ratio (PR): 4.5 (95% CI: 1.4, 14.2)], and partner HCV+ [PR: 7.2 (95% CI: 1.8, 29.5)]. CONCLUSIONS The HIV epidemic in the Republic of Georgia is closely tied to the IDU community. Evidence-based interventions targeting IDU and partners of IDU are urgently required to halt the spread of the HIV epidemic in the country.
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Zhang L, Li J, Lai W, Feng L, Zeng Y, Liu L, Hu Y, Liu J, Zhang X, Wu P, Vermund SH, Jia Y. Prevalence and correlates of needle-sharing among new and long-term injection drug users in southwest China. Subst Use Misuse 2010; 45:2503-2523. [PMID: 20536355 DOI: 10.3109/10826084.2010.487234] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Three community-based surveys recruited 4,310 injection drug users (IDUs) in China from 2004 to 2006. Of the participants, 54.4% were ≤ 3-year new IDUs; 63.9% reported injecting more than two times daily; 31.5% shared needles in the last six months; 37.4% shared equipments in the last month; 30.2% reported their regular sex partners injected drugs; and 23.5% had commercial sex, with 52.2% reporting no condom use during last sex. The risky injection practices (sharing needles/equipments and high injection frequency) were less frequent among new IDUs, emphasizing that effective prevention needs to identify and intervene with IDUs early on. The study's limitations are noted.
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Affiliation(s)
- Linglin Zhang
- Institute for AIDS/STI Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, PR China
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The incidence of hepatitis E virus infection in the general population of the USA. Epidemiol Infect 2010; 139:1145-50. [PMID: 20854712 DOI: 10.1017/s0950268810002177] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Hepatitis E virus (HEV) infection is as an emerging disease of global importance because it is one of the major causes of acute hepatitis worldwide. There are few reports on the incidence of HEV in the USA. For better assessing the burden of primary HEV infection as well as understanding the epidemiology of HEV in the US population this analysis was conducted to estimate the force of infection of HEV in the USA. HEV force of infection in the general US population was calculated using catalytic models as cumulative markers of past infection from HEV seroprevalence data from the NHANES Survey. In the US population the force of infection was seven infections per 1000 susceptible persons per year. This study shows that in the USA HEV can be acquired locally and from developing countries. HEV is circulating more frequently in the non-Hispanic White racial/ethnic group and those who consume fish more frequently.
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Mackridge AJ, Beynon CM, McVeigh J, Whitfield M, Chandler M. Meeting the health needs of problematic drug users through community pharmacy: A qualitative study. JOURNAL OF SUBSTANCE USE 2010. [DOI: 10.3109/14659890903513459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beynon CM, Taylor A, Allen E, Bellis MA. Visual versus written cues: a comparison of drug injectors' responses. Have surveys using the written word underestimated risk behaviors for hepatitis C? Subst Use Misuse 2010; 45:1491-508. [PMID: 20438331 DOI: 10.3109/10826081003754021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined differences in responses of injecting drug users (IDUs) about sharing injecting paraphernalia using written questions ("written cues") versus video recordings of IDUs engaged in sharing behaviors ("visual cues"). Data were collected in 2007 in cities Liverpool, England and Glasgow, Scotland (N = 204). Participants completed a computer-assisted questionnaire with questions about sharing asked using visual and written cues. McNemar's chi-squared tests and logistic regression models were used. Respondents provided significantly different responses to questions about sharing when asked using visual versus written cues; a considerable proportion of IDUs said they had never shared via front/back loading and via sharing water/bleach for flushing out injecting equipment using written cues but confirmed they had participated in these behaviors when asked using visual cues. Implications and future research are discussed.
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Affiliation(s)
- Caryl M Beynon
- Centre for Public Health Research Directorate, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, Castle House, Liverpool, UK.
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Day CA, White B, Dore GJ, van Beek I, Rodgers C, Cunningham P, Wodak A, Maher L. Hepatitis B virus among injecting drug users in Sydney, Australia: prevalence, vaccination and knowledge of status. Drug Alcohol Depend 2010; 108:134-7. [PMID: 20047803 DOI: 10.1016/j.drugalcdep.2009.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/08/2009] [Accepted: 11/10/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite the availability of an inexpensive and safe vaccine, injecting drug users (IDUs) remain at risk of hepatitis B virus (HBV) infection. This paper aimed to measure HBV prevalence and vaccination coverage and to assess knowledge and concordance of status among IDUs. METHODS Participants were recruited through a primary health care and a drug treatment service and via street press in Sydney, Australia. Face-to-face interviews were conducted and serology collected. All received $30 for participation. RESULTS 229 participants were recruited, serology was available for 209. Almost all those interviewed had been tested for HBV (95%) a median of four (IQR 2-10) times and 61% had been tested in the preceding year. Fifty-four percent had evidence of previous infection (anti-HBc) and 5% were HBsAg positive. Only 27% had serological evidence of vaccination immunity; however, 43% of the sample recalled having being told by a health professional that they were vaccinated against HBV. Although only three participants reported they did not understand the results of their last HBV test, confusion was evident based on self-reported status. CONCLUSIONS Levels of understanding and vaccination coverage were low while evidence of prior infection was high among this IDU sample. This is cause for concern given the majority of participants were recruited through primary care and treatment services. Strategies to bolster vaccination among this group will be discussed.
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Affiliation(s)
- Carolyn A Day
- Drug Health Services, Central Clinical School (C39), University of Sydney, NSW 2006, Australia.
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Ben-Alaya-Bouafif N, Bahri O, Chlif S, Bettaieb J, Toumi A, Bel Haj HN, Zâatour A, Gharbi A, Dellagi K, Triki H, Ben Salah A. Heterogeneity of hepatitis B transmission in Tunisia: Risk factors for infection and chronic carriage before the introduction of a universal vaccine program. Vaccine 2010; 28:3301-7. [DOI: 10.1016/j.vaccine.2010.02.101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 02/16/2010] [Accepted: 02/24/2010] [Indexed: 11/29/2022]
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Lidman C, Norden L, Kåberg M, Käll K, Franck J, Aleman S, Birk M. Hepatitis C infection among injection drug users in Stockholm Sweden: prevalence and gender. ACTA ACUST UNITED AC 2010; 41:679-84. [PMID: 19521924 DOI: 10.1080/00365540903062143] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hepatitis C virus (HCV) infection is widespread among injection drug users. Young women seem to be at higher risk of acquiring HCV. To optimize future intervention and prevention measures, we studied the epidemiology of human immunodeficiency virus (HIV), hepatitis B (HBV), and HCV infection among men and women. Inclusion criteria for this cross-sectional multicentre study were: history of ever injecting drugs, age > 18 y, and no previous HIV diagnosis. In 310 participants, plasma/serum samples were analysed for HBV, HIV and HCV (anti-HCV, HCV-RNA, and HCV genotype). HCV antibodies were noted in 268 (86.5%) participants, of whom 207 (77.0%) also had detectable HCV-RNA. Genotypes 1 and 3 dominated, at 35.9% and 33.0%, respectively. Women acquired HCV (but not HBV) to a significantly higher degree (RR 2.97, 95% confidence interval 1.11-7.93) during the first y of injecting drugs. They also recovered spontaneously from HCV infection more frequently (RR 2.49, 95% CI 1.28-4.53). The HCV prevalence of about 50% within 2 y after initiation of injection drug use underlines the need for early intervention efforts. Possible causes for higher HCV prevalence and the implications of favourable spontaneous recovery rates among women should be considered when designing intervention and prevention measures.
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Affiliation(s)
- Christer Lidman
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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Antoniou M, Messaritakis I, Christodoulou V, Ascoksilaki I, Kanavakis N, Sutton AJ, Carson C, Courtenay O. Increasing incidence of zoonotic visceral leishmaniasis on Crete, Greece. Emerg Infect Dis 2009; 15:932-4. [PMID: 19523295 PMCID: PMC2727332 DOI: 10.3201/eid1506.071666] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine whether the incidence of canine leishmaniasis has increased on Crete, Greece, we fitted infection models to serodiagnostic records of 8,848 dog samples for 1990–2006. Models predicted that seroprevalence has increased 2.4% (95% confidence interval 1.61%–3.51%) per year and that incidence has increased 2.2- to 3.8-fold over this 17-year period.
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The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis. J Acquir Immune Defic Syndr 2009; 51:462-9. [DOI: 10.1097/qai.0b013e3181a2539a] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sweeting M, De Angelis D, Ades A, Hickman M. Estimating the prevalence of ex-injecting drug use in the population. Stat Methods Med Res 2009; 18:381-95. [PMID: 19036912 DOI: 10.1177/0962280208094704] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Injecting drug use is the main route of transmission for the hepatitis C virus in the developed world. Knowledge about the characteristics of the past and current injecting drug user (IDU) population is therefore vital in order to understand the epidemiology of hepatitis C. The IDU population is ;hard to reach' and hence most epidemiological studies have concentrated on estimating current IDU prevalence, whilst little is known about the potentially large pool of ex-injectors. We demonstrate a method for estimating the proportion of ex-users in the population, by considering injecting drug use as a time-to-event process. We show how unbiased estimates of injecting duration and historical patterns in injecting initiation can be derived from a sample of ex-IDUs obtained from a population survey, and how such data lead to estimates of the proportion of ex-IDUs in the population. Finally, we show how to obtain estimates of the prevalence of ex-IDUs by using additional information on the prevalence of current IDUs.
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Affiliation(s)
- Mj Sweeting
- MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR, UK.
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50
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Jauffret-Roustide M, Le Strat Y, Couturier E, Thierry D, Rondy M, Quaglia M, Razafandratsima N, Emmanuelli J, Guibert G, Barin F, Desenclos JC. A national cross-sectional study among drug-users in France: epidemiology of HCV and highlight on practical and statistical aspects of the design. BMC Infect Dis 2009; 9:113. [PMID: 19607712 PMCID: PMC2733898 DOI: 10.1186/1471-2334-9-113] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 07/16/2009] [Indexed: 12/01/2022] Open
Abstract
Background Epidemiology of HCV infection among drug users (DUs) has been widely studied. Prevalence and sociobehavioural data among DUs are therefore available in most countries but no study has taken into account in the sampling weights one important aspect of the way of life of DUs, namely that they can use one or more specialized services during the study period. In 2004–2005, we conducted a national seroepidemiologic survey of DUs, based on a random sampling design using the Generalised Weight Share Method (GWSM) and on blood testing. Methods A cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once in their life. We conducted a two stage random survey of DUs selected to represent the diversity of drug use. The fact that DUs can use more than one structure during the study period has an impact on their inclusion probabilities. To calculate a correct sampling weight, we used the GWSM. A sociobehavioral questionnaire was administered by interviewers. Selected DUs were asked to self-collect a fingerprick blood sample on blotting paper. Results Of all DUs selected, 1462 (75%) accepted to participate. HCV seroprevalence was 59.8% [95% CI: 50.7–68.3]. Of DUs under 30 years, 28% were HCV seropositive. Of HCV-infected DUs, 27% were unaware of their status. In the month prior to interview, 13% of DUs shared a syringe, 38% other injection parapharnelia and 81% shared a crack pipe. In multivariate analysis, factors independently associated with HCV seropositivity were age over 30, HIV seropositivity, having ever injected drugs, opiate substitution treatment (OST), crack use, and precarious housing. Conclusion This is the first time that blood testing combined to GWSM is applied to a DUs population, which improve the estimate of HCV prevalence. HCV seroprevalence is high, indeed by the youngest DUs. And a large proportion of DUs are not aware of their status. Our multivariate analysis identifies risk factors such as crack consumption and unstable housing.
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Affiliation(s)
- Marie Jauffret-Roustide
- Infectious Diseases Departement, National Institute for Public Health Surveillance, Saint-Maurice, France.
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