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

doi:10.1093/aje/kwz097

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 journal › Article › peer-review

39 Scopus citations

Abstract

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 language	English
Pages (from-to)	1539-1551
Number of pages	13
Journal	American Journal of Epidemiology
Volume	188
Issue number	8
DOIs	https://doi.org/10.1093/aje/kwz097
State	Published - 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.

Funding

Author affiliations: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Hannah Fraser, Jack Stone, Matthew Hickman, Natasha K. Martin, Peter Vickerman); Division of Medical Affairs, Grady Health System, Atlanta, Georgia (Claudia Vellozzi); RTI International, Research Triangle Park, Raleigh, North Carolina (Thomas J. Hoerger, Alex H. Kral, Carolina Barbosa, Jon Zibbell); Institute for Global Health Sciences, University of California San Francisco, San Francisco, California (Jennifer L. Evans); Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky (Jennifer Havens, April M. Young); Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky (April M. Young); Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Senad Handanagic, Lina Nerlander); Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia (Susan Hariri, John W. Ward); Department of Chemistry, University of Colorado, Denver, Colorado (Alyssa Leib); Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, California (Natasha K. Martin); Center for Public Health Research, Population Health Division, San Francisco Department of Public Health, San Francisco, California (Henry F. Raymond); Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico (Kimberly Page); and Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia (John W. Ward). C.V. was an employee of the US Centers for Disease Control and Prevention at the time the study began. A.L. was an employee of RTI International at the time the study began. This study was supported by the Centers for Disease Control and Prevention (contract 200-2013-M-53964B GS-10F-0097L to RTI International) and a subcontract from RTI International to the University of Bristol. N.K.M., P.V., and M.H. were additionally supported by the National Institute for Drug Abuse (grant R01 DA037773), and N.M. was partially funded by the University of California San Diego Center for AIDS Research, a National Institutes of Health– funded program (grant P30 AI036214). P.V. and M.H. acknowledge that the research was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England (PHE). J.L.E. and K.P. were supported by the National Institute for Drug Abuse (grant 3-R01 DA016017-14), as was J.H. (grant R01 DA024598). J.S. acknowledges funding from a PhD scholarship from the Engineering and Physical Sciences Research Council. The views expressed in this paper are solely those of the authors and not necessarily those of the Centers for Disease Control and Prevention (CDC), RTI International, the University of Bristol, the National Health Service (NHS), the National Institute of Health Research (NIHR), the Department of Health and Social Care, or Public Health England (PHE). Conflict of interest: 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. H.F. has received an honorarium from MSD. J.S. has received a conference attendance sponsorship from Gilead. K.P. has received research grant funding from Gilead unrelated to this work. The other authors report no conflicts.

Funders	Funder number
Gilead UK and Ireland Corporate Contributions
National Institute for Health Research Health Protection Research Unit
National Institutes of Health (NIH)
Center for AIDS Research, University of California, San Diego
UK Medical Research Council, Engineering and Physical Sciences Research Council
University Hospitals Bristol NHS Foundation Trust and the University of Bristol
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse	R01DA033862, R01DA024598, R01DA037773
Public Health England	3-R01 DA016017-14, R01 DA024598
National Institute of Allergy and Infectious F32-AI286447 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R01AI168214 Jason W. Rosch Diseases National Institute of Allergy and Infectious P30 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R00-AI166116 Christopher D. Radka Diseases National Institute of Allergy and Infectious T32-AI106700 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R01AI192221 Jason W. Rosch Diseases National Inst...	P30AI036214
Centers for Disease Control and Prevention	200-2013-M-53964B GS-10F-0097L

UN SDGs

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

SDG 3 Good Health and Well-being

Keywords

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

ASJC Scopus subject areas

Epidemiology

Access to Document

10.1093/aje/kwz097

Cite this

Fraser, H., Vellozzi, C., Hoerger, T. J., Evans, J. L., Kral, A. H., Havens, J., Young, A. M., Stone, J., Handanagic, S., Hariri, S., Barbosa, C., Hickman, M., Leib, A., Martin, N. K., Nerlander, L., Raymond, H. F., Page, K., Zibbell, J., Ward, J. W., & Vickerman, P. (2019). Scaling Up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States: A Rural and Urban Comparison. American Journal of Epidemiology, 188(8), 1539-1551. https://doi.org/10.1093/aje/kwz097

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

abstract = "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.",

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Fraser, H, Vellozzi, C, Hoerger, TJ, Evans, JL, Kral, AH, Havens, J , Young, AM, Stone, J, Handanagic, S, Hariri, S, Barbosa, C, Hickman, M, Leib, A, Martin, NK, Nerlander, L, Raymond, HF, Page, K, Zibbell, J, Ward, JW & Vickerman, P 2019, 'Scaling Up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States: A Rural and Urban Comparison', American Journal of Epidemiology, vol. 188, no. 8, pp. 1539-1551. https://doi.org/10.1093/aje/kwz097

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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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