Scaling Up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States: A Rural and Urban Comparison

Hannah Fraser, Claudia Vellozzi, Thomas J. Hoerger, Jennifer L. Evans, Alex H. Kral, Jennifer Havens, April M. Young, Jack Stone, Senad Handanagic, Susan Hariri, Carolina Barbosa, Matthew Hickman, Alyssa Leib, Natasha K. Martin, Lina Nerlander, Henry F. Raymond, Kimberly Page, Jon Zibbell, John W. Ward, Peter Vickerman

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


In the United States, hepatitis C virus (HCV) transmission is rising among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modeling, we investigated the impact of scaling up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky, and San Francisco, California, where HCV seroprevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban San Francisco (established community) than in rural Perry County (young, expanding community). We modeled the proportion of HCV-infected PWID needing HCV treatment annually to reduce HCV incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (Perry County only) from 2017. With current MAT and SSP coverage during 2017-2030, HCV incidence would increase in Perry County (from 21.3 to 22.6 per 100 person-years) and decrease in San Francisco (from 12.9 to 11.9 per 100 person-years). With concurrent MAT and SSP scale-up, 5% per year of HCV-infected PWID would need HCV treatment in Perry County to achieve incidence targets - 13% per year without MAT and SSP scale-up. In San Francisco, a similar proportion would need HCV treatment (10% per year) irrespective of MAT scale-up. Reaching the same impact by 2025 would require increases in treatment rates of 45%-82%. Achievable provision of HCV treatment, alongside MAT and SSP scale-up (Perry County) and MAT scale-up (San Francisco), could reduce HCV incidence.

Original languageEnglish
Pages (from-to)1539-1551
Number of pages13
JournalAmerican Journal of Epidemiology
Issue number8
StatePublished - Aug 1 2019

Bibliographical note

Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.


  • direct-acting-antiviral HCV treatment
  • hepatitis C virus
  • medication-assisted treatment
  • modeling
  • people who inject drugs
  • syringe service programs

ASJC Scopus subject areas

  • General Medicine


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