Monitoring the hepatitis C epidemic in England and evaluating intervention scale-up using routinely collected data

Ross J. Harris*, Helen Harris, Sema Mandal, Mary Ramsay, Peter Vickerman, Matthew Hickman, Daniela De Angelis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

In England, 160 000 individuals were estimated to be chronically infected with hepatitis C virus (HCV) in 2005 and the burden of severe HCV-related liver disease has increased steadily for the past 15 years. Direct-acting antiviral treatments can clear infection in most patients, motivating HCV elimination targets. However, the current burden of HCV is unknown and new methods are required to monitor progress. We employed a Bayesian back-calculation approach, combining data on severe HCV-related liver disease and disease progression, to reconstruct historical HCV incidence and estimate current prevalence in England. We explicitly modelled infections occurring in people who inject drugs, the key risk group, allowing information on the size of this population and surveillance data on HCV prevalence to inform recent incidence. We estimated that there were 143 000 chronic infections in 2015 (95% credible interval 123 000-161 000), with 34% and 54% in those with recent and past injecting drug use, respectively. Following the planned scale-up of new treatments, chronic infections were predicted to fall to 113 400 (94 900-132 400) by the end of 2018 and to 89 500 (71 300-108 600) by the end of 2020. Numbers developing severe HCV-related liver disease were predicted to fall by at least 24% from 2015 to 2020. Thus, we describe a coherent framework to monitor progress using routinely collected data, which can be extended to incorporate additional data sources. Planned treatment scale-up is likely to achieve 2020 WHO targets for HCV morbidity, but substantial efforts will be required to ensure that HCV testing and patient engagement are sufficiently high.

Original languageEnglish
Pages (from-to)541-551
Number of pages11
JournalJournal of Viral Hepatitis
Volume26
Issue number5
DOIs
Publication statusPublished - May 2019

Bibliographical note

Funding Information:
RH, HH, SM and MR are core-funded by Public Health England. PV and MH are employed by the University of Bristol and part-funded by the NIHR Health Protection Research Unit in Evaluation of Interventions. DDA is funded by the Medical Research Council, Public Health England and NIHR Health Protection Research Unit in Evaluation of Interventions. Public Health England funds and coordinates the Unlinked Anonymous Monitoring survey on people who inject drugs, and collects data on laboratory reports of HCV testing. Public Health England, the University of Bristol, the NIHR and the MRC had no involvement in the analysis or interpretation of the data, or the decision to submit this article for publication.

Funding Information:
Funding information RH, HH, SM and MR are core-funded by Public Health England. PV and MH are employed by the University of Bristol and part-funded by the NIHR Health Protection Research Unit in Evaluation of Interventions. DDA is funded by the Medical Research Council, Public Health England and NIHR Health Protection Research Unit in Evaluation of Interventions. Public Health England funds and coordinates the Unlinked Anonymous Monitoring survey on people who inject drugs, and collects data on laboratory reports of HCV testing. Public Health England, the University of Bristol, the NIHR and the MRC had no involvement in the analysis or interpretation of the data, or the decision to submit this article for publication. We are grateful for the support of the National Strategy Group on Viral Hepatitis, whose members provided valuable input for this work, and Dr Paul Birrell for his insights on Bayesian modelling. We thank all the participants of the Unlinked Anonymous Monitoring survey on people who inject drugs who give their time to provide this invaluable resource.

Publisher Copyright:
© 2019 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons

Keywords

  • back calculation
  • direct-acting antiviral treatment
  • disease burden
  • people who inject drugs
  • surveillance data

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