Eliminating hepatitis C: The importance of frequent testing of people who inject drugs in high-prevalence settings

Nick Scott, Rachel Sacks-Davis, Alisa Pedrana, Joseph Doyle, Alexander Thompson, Margaret Hellard

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14 Citations (Scopus)

Abstract

Modelling suggests that more frequent screening of people who inject drugs (PWID) and an improved care cascade are required to achieve the WHO hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030. We determined the testing frequencies (2-yearly, annually, 6-monthly and 3-monthly) and retention in care required among PWID to achieve the HCV incidence reduction target through treatment as prevention in low (25%), medium (50%) and high (75%) chronic HCV prevalence settings. Mathematical modelling of HCV transmission among PWID, capturing testing, treatment and other features of the care cascade were employed. In low-prevalence settings, 2-yearly antibody testing of PWID was estimated to reach the elimination target by 2027-2030 depending on retention in care, with annual testing reducing the time by up to 3 years. In medium-prevalence settings, if close to 90% testing coverage were achieved, then annual antibody testing of PWID would be sufficient. If testing coverage were lower (80%), 6-monthly antibody testing with at least 70% retention in care or annual HCV RNA/cAg testing would be required. In high-prevalence settings, even 3-monthly HCV RNA/cAg testing of PWID was unable to achieve the incidence reduction target. Thus, for geographical areas or subpopulations with high prevalence, WHO incidence targets are unlikely to be met without 3-monthly RNA/cAg testing accompanied by other prevention measures. Novel testing strategies, such as rapid point-of-care antibody testing or replacing antibody testing with RNA/cAg tests as a screening tool, can provide additional population-level impacts to compensate for imperfect follow-up or testing coverage.

Original languageEnglish
Pages (from-to)1472-1480
Number of pages9
JournalJournal of Viral Hepatitis
Volume25
Issue number12
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • care cascade
  • direct-acting antiviral
  • elimination
  • hepatitis C virus
  • mathematical model
  • people who inject drugs
  • testing

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