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The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study

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 cascad...

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Autores principales: Cousien, Anthony, Leclerc, Pascale, Morissette, Carole, Bruneau, Julie, Roy, Élise, Tran, Viet Chi, Yazdanpanah, Yazdan, Cox, Joseph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320702/
https://www.ncbi.nlm.nih.gov/pubmed/28222681
http://dx.doi.org/10.1186/s12879-017-2256-5
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author Cousien, Anthony
Leclerc, Pascale
Morissette, Carole
Bruneau, Julie
Roy, Élise
Tran, Viet Chi
Yazdanpanah, Yazdan
Cox, Joseph
author_facet Cousien, Anthony
Leclerc, Pascale
Morissette, Carole
Bruneau, Julie
Roy, Élise
Tran, Viet Chi
Yazdanpanah, Yazdan
Cox, Joseph
author_sort Cousien, Anthony
collection PubMed
description 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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spelling pubmed-53207022017-02-24 The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study Cousien, Anthony Leclerc, Pascale Morissette, Carole Bruneau, Julie Roy, Élise Tran, Viet Chi Yazdanpanah, Yazdan Cox, Joseph BMC Infect Dis Research Article 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. BioMed Central 2017-02-21 /pmc/articles/PMC5320702/ /pubmed/28222681 http://dx.doi.org/10.1186/s12879-017-2256-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Cousien, Anthony
Leclerc, Pascale
Morissette, Carole
Bruneau, Julie
Roy, Élise
Tran, Viet Chi
Yazdanpanah, Yazdan
Cox, Joseph
The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study
title The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study
title_full The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study
title_fullStr The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study
title_full_unstemmed The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study
title_short The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study
title_sort need for treatment scale-up to impact hcv transmission in people who inject drugs in montréal, canada: a modelling study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320702/
https://www.ncbi.nlm.nih.gov/pubmed/28222681
http://dx.doi.org/10.1186/s12879-017-2256-5
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