Presentation is loading. Please wait.

Presentation is loading. Please wait.

Hepatitis C prevention among people who inject drugs: reducing transmission in PWID by scaling up HCV treatment, OST and needle exchange services Matt.

Similar presentations


Presentation on theme: "Hepatitis C prevention among people who inject drugs: reducing transmission in PWID by scaling up HCV treatment, OST and needle exchange services Matt."— Presentation transcript:

1 Hepatitis C prevention among people who inject drugs: reducing transmission in PWID by scaling up HCV treatment, OST and needle exchange services Matt Hickman, Natasha Martin, Peter Vickerman

2 Acknowledgements NIHR Health Protection Research Unit in Evaluation of Interventions Health Protection Scotland: HCV Action Plan NIHR PDG Can HCV treatment be delivered to injecting drug users… European Commission Drug Prevention and Information Programme (DIPP) “Treatment as Prevention in Europe…” NIHR (HS&DR) (12/3070/13) - Assessing the impact and cost- effectiveness of NSP on HCV The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Collaborators:- Sharon J Hutchinson, Graham R Foster, John F Dillon, Fiona Gordon, Javier Vilar, Matthew Cramp, Stephen Ryder, David J Goldberg, Daniela De Angelis, Will Irving, Viv Hope, Noel Craine, Marion Lyons, Norah Palmateer, Esther Aspinall

3 EPIDEMIOLOGY

4 > 90% HCV acquired in UK among PWID Sweeting et al. Biostatistics 2008; De Angelis et al, Statistics in Med Research 2009; Ross et al EJPH 2011 ~15,000 White; 11,000 (IPB)

5 OST/HIGH COVERAGE NSP (HC_NSP) EFFECTIVENESS Use recent pooled UK evidence for impact of harm reduction on an individual’s risk of recent HCV infection 1 Effect EstimatesAOR 1 95% CI HC_NSP OST OST and HC_NSP adjusted for: gender, crack, homeless, injecting duration HC_NSP is defined as exchanging more syringes than you inject Turner K et al. Addiction 2011; 106:

6 CAN SCALING UP COVERAGE OF OST & NSP ACHIEVE FURTHER SUBSTANTIAL REDUCTIONS IN HCV AMONG PWID

7 Modeling transitions between OST and NSP & transmission of HCV Vickerman et al Addiction 2012 doi: /j x

8 Impact of changing coverage of OST and NSP from 50%: 0%, 60%-80% Vickerman et al Addiction 2012 doi: /j x

9 SCALING UP HCV TREATMENT AS PREVENTION

10 Non-SVR infected PWID Chronically infected PWID Uninfected PWID Antiviral treatment Allow for re-infection New PWID Cease/die Acutely infected PWID Infection Spontaneous clearance Need Dynamic Model to Assess Intervention Impact on HCV Prevalence Martin NK, Vickerman P, Foster GR, Hutchinson SJ, Goldberg DJ, and Hickman M. J Hep 2011; 54:

11 MODELLING HCV TREATMENT AS PREVENTION HCV RELATIVE PREVALENCE REDUCTIONS AT 10 YEARS WITH PEGIFN+RBV

12 Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, and Vickerman P. Combination interventions to prevent HCV transmission among people who inject drugs: modelling the impact of antiviral treatment, needle and syringe programmes, and opiate substitution therapy. Clinical Infectious Diseases % chronic prevalence Dark red: modest (<20%) impact, high HCV Orange: ~50% impact White: >80% impact COMBINATION PREVENTION SCALE-UP (OST/NSP/DAAS): 10 YEAR RELATIVE PREVALENCE REDUCTIONS WITH NO BASELINE COVERAGE OF OST/NSP AND USING DAAs >40% reduction requires HCV treatment OST&NSP increases benefit of HCV treatment

13 HCV TREATMENT & TREATING PWID IS COST-EFFECTIVE SO IN NEW DAA ERA - WHICH PATIENTS SHOULD BE TARGETED?

14

15 Cost-effectiveness efficiency frontiers – 20% chronic HCV new DAA Treating PWID/non-exPWID with mild or moderate HCV compared to delayed treatment until cirrhosis. Treatment scenarios above frontier are dominated (more expensive, fewer benefits)

16 Cost-effectiveness efficiency frontiers – 40% chronic HCV new DAA

17 Cost-effectiveness efficiency frontiers – 60% chronic HCV new DAA

18 ARE CURRENT HCV TREATMENT RATES SUFFICIENT?

19 Blue: Baseline in 2014 White box: 2024, No scale-up, ITT SVR with IFN/RBV Bristol E London Manchester Nottingham Plymouth Dundee N Wales HCV chronic prevalence among PWID (%) TREATMENT IMPACT IN SEVEN UK CITIES WITH CURRENT RATES/SVR Martin NK, JVH 2014

20 Blue: Baseline in 2014 White box: 2024, No scale-up, ITT SVR with IFN/RBV Black: 2024, Scale-up to 26/1000 annually with IFN-free DAAs (all genotypes) in 2016 Bristol E London Manchester Nottingham Plymouth Dundee N Wales HCV chronic prevalence among PWID (%) TREATMENT IMPACT IN SEVEN UK CITIES WITH SCALE-UP/DAAs Martin NK, JVH 2014

21 HCV ELIMINATION – MYTH OR REALITY

22 Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, and Vickerman P. Combination interventions to prevent HCV transmission among people who inject drugs: modelling the impact of antiviral treatment, needle and syringe programmes, and opiate substitution therapy. Clinical Infectious Diseases 2013 COMBINATION PREVENTION SCALE-UP (from 50% OST/NSP & DAAS): 10 YEAR RELATIVE PREVALENCE REDUCTIONS 40% CHRONIC HCV Towards Elimination: scaling up HCV treatment rates to per 1000PWID & 60% OST&NSP coverage reduces HCV prevalence by 60-80% in 10 years.

23 HCV prevalence reduction – combining interventions HCV treatment scale-up essential to achieve substantial reductions in HCV prevalence Current treatment rates maybe insufficient to achieve observable reductions (in UK) OST&NSP increase benefits of HCV treatment as prevention HCV treatment of PWID is cost-effective – and in many scenarios more cost-effective than treating ex/non-PWID or delaying treatment until cirrhosis. Now need empirical evidence to test model projections


Download ppt "Hepatitis C prevention among people who inject drugs: reducing transmission in PWID by scaling up HCV treatment, OST and needle exchange services Matt."

Similar presentations


Ads by Google