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?

Zoe Ward; Lucy Platt; Sedona Sweeney; Vivian Hope; Lisa Maher; Sharon Hutchinson; Norah Palmateer; Josie Smith; Noel Craine; Avril Taylor; Natasha Martin; Rachel Ayres; John Dillon; Matthew Hickman; Peter Vickerman

doi:10.1111/add.14217

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?

Zoe Ward^*, Lucy Platt, Sedona Sweeney, Vivian Hope, Lisa Maher, Sharon Hutchinson, Norah Palmateer, Josie Smith, Noel Craine, Avril Taylor, Natasha Martin, Rachel Ayres, John Dillon, Matthew Hickman, Peter Vickerman

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1727-1738
Number of pages	12
Journal	Addiction
Volume	113
Issue number	9
DOIs	https://doi.org/10.1111/add.14217
Publication status	Published - Sept 2018

Bibliographical note

Funding Information:
This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. acknowledge support from the National Institute of Health Research Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship.

Funding Information:
This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. acknowledge support from the National Institute of Health Research Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship. N.K.M. and P.V. have received unrestricted research grants from Gilead unrelated to this work, and N.K.M. has received honoraria from Merck, AbbVie and Janssen. M.H. has received honoraria unrelated to this work from Merck, Abbvie and Gilead and declares no conflicts of interest.

Publisher Copyright:
© 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Keywords

HCV treatment scale-up
hepatitis C virus
mathematical model
needle and syringe provision
opioid substitution therapy
people who inject drugs

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Ward, Z., Platt, L., Sweeney, S., Hope, V., Maher, L., Hutchinson, S., Palmateer, N., Smith, J., Craine, N., Taylor, A., Martin, N., Ayres, R., Dillon, J., Hickman, M., & Vickerman, P. (2018). 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, 113(9), 1727-1738. https://doi.org/10.1111/add.14217

@article{9bcf20bccbad466dbe91249a7c08450b,

title = "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?",

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.",

keywords = "HCV treatment scale-up, hepatitis C virus, mathematical model, needle and syringe provision, opioid substitution therapy, people who inject drugs",

author = "Zoe Ward and Lucy Platt and Sedona Sweeney and Vivian Hope and Lisa Maher and Sharon Hutchinson and Norah Palmateer and Josie Smith and Noel Craine and Avril Taylor and Natasha Martin and Rachel Ayres and John Dillon and Matthew Hickman and Peter Vickerman",

note = "Funding Information: This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. acknowledge support from the National Institute of Health Research Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship. Funding Information: This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. acknowledge support from the National Institute of Health Research Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship. N.K.M. and P.V. have received unrestricted research grants from Gilead unrelated to this work, and N.K.M. has received honoraria from Merck, AbbVie and Janssen. M.H. has received honoraria unrelated to this work from Merck, Abbvie and Gilead and declares no conflicts of interest. Publisher Copyright: {\textcopyright} 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.",

year = "2018",

month = sep,

doi = "10.1111/add.14217",

language = "English",

volume = "113",

pages = "1727--1738",

journal = "Addiction",

issn = "0965-2140",

publisher = "wiley",

number = "9",

}

Ward, Z, Platt, L, Sweeney, S, Hope, V, Maher, L, Hutchinson, S, Palmateer, N, Smith, J, Craine, N, Taylor, A, Martin, N, Ayres, R, Dillon, J, Hickman, M & Vickerman, P 2018, '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, vol. 113, no. 9, pp. 1727-1738. https://doi.org/10.1111/add.14217

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? / Ward, Zoe; Platt, Lucy; Sweeney, Sedona et al.
In: Addiction, Vol. 113, No. 9, 09.2018, p. 1727-1738.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 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?

AU - Ward, Zoe

AU - Platt, Lucy

AU - Sweeney, Sedona

AU - Hope, Vivian

AU - Maher, Lisa

AU - Hutchinson, Sharon

AU - Palmateer, Norah

AU - Smith, Josie

AU - Craine, Noel

AU - Taylor, Avril

AU - Martin, Natasha

AU - Ayres, Rachel

AU - Dillon, John

AU - Hickman, Matthew

AU - Vickerman, Peter

N1 - Funding Information: This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. acknowledge support from the National Institute of Health Research Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship. Funding Information: This study was supported by National Institute of Health Research Public Health Research Programme (grant number PHP Project: 12/3070/13) and the National Institute for Health Research Health Protection Research Unit (HPRU-2012-10026) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the University of Bristol. N.K.M., P.V. and M.H. were additionally supported by the National Institute for Drug Abuse (grant number R01 DA037773-01A1), and N.M. was partially funded by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) - funded program (grant number P30 AI036214). P.V. and M.H. acknowledge support from the National Institute of Health Research Health Protection Research Unit in Evaluation of Interventions. L.M. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship. N.K.M. and P.V. have received unrestricted research grants from Gilead unrelated to this work, and N.K.M. has received honoraria from Merck, AbbVie and Janssen. M.H. has received honoraria unrelated to this work from Merck, Abbvie and Gilead and declares no conflicts of interest. Publisher Copyright: © 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

KW - HCV treatment scale-up

KW - hepatitis C virus

KW - mathematical model

KW - needle and syringe provision

KW - opioid substitution therapy

KW - people who inject drugs

UR - http://www.scopus.com/inward/record.url?scp=85047486630&partnerID=8YFLogxK

U2 - 10.1111/add.14217

DO - 10.1111/add.14217

M3 - Article

AN - SCOPUS:85047486630

SN - 0965-2140

VL - 113

SP - 1727

EP - 1738

JO - Addiction

JF - Addiction

IS - 9

ER -

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?

Abstract

Bibliographical note

Keywords

UN SDGs

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