What is required for achieving hepatitis C virus elimination in Singapore? A modeling study.
Elimination
Epidemic
Hepatitis C virus
Liver disease
Modeling
Opioid substitution therapy (OST)
People who inject drugs (PWID)
Prevention
Public health
Treatment
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
revised:
09
07
2020
received:
15
02
2020
accepted:
05
08
2020
pubmed:
11
8
2020
medline:
25
9
2021
entrez:
11
8
2020
Statut:
ppublish
Résumé
The vast majority of hepatitis C virus (HCV) infection in Singapore is among those with a history of injecting drug use (IDU), yet harm reduction is not available and what is required to achieve the World Health Organization (WHO) HCV elimination targets (80% incidence reduction and 65% mortality reduction by 2030) is unknown. We model the intervention scale-up required to achieve WHO targets in Singapore. A dynamic model of HCV transmission and progression among those with a history of IDU was calibrated to Singapore, a setting with declining IDU and no harm reduction (~11 000 people with IDU history in 2017 and 45% HCV seropositive). We projected HCV treatment scale-up from 2019 required to achieve WHO targets with varying prioritization scenarios, with/without opiate substitution therapy scale-up (to 40% among people who inject drugs [PWID]). We estimated 3855 (95% confidence interval: 2635-5446) chronically HCV-infected individuals with a history of IDU and 148 (87-284) incident HCV cases in Singapore in 2019. Reaching the HCV incidence target requires 272 (187-384) treatments in 2019, totaling 2444 (1683-3452) across 2019-2030. By prioritizing PWID or PWID and cirrhotics, 60% or 30% fewer treatments are required, respectively, whereas the target cannot be achieved with cirrhosis prioritization. Opiate substitution therapy scale-up reduces treatments required by 21-24%. Achieving both WHO targets requires treating 631 (359-1047) in 2019, totaling 3816 (2664-5423) across 2019-2030. Hepatitis C virus elimination is achievable in Singapore but even with declining IDU requires immediate treatment scale-up among PWID. Harm reduction provision reduces treatments required and provides additional benefits.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
The vast majority of hepatitis C virus (HCV) infection in Singapore is among those with a history of injecting drug use (IDU), yet harm reduction is not available and what is required to achieve the World Health Organization (WHO) HCV elimination targets (80% incidence reduction and 65% mortality reduction by 2030) is unknown. We model the intervention scale-up required to achieve WHO targets in Singapore.
METHODS
METHODS
A dynamic model of HCV transmission and progression among those with a history of IDU was calibrated to Singapore, a setting with declining IDU and no harm reduction (~11 000 people with IDU history in 2017 and 45% HCV seropositive). We projected HCV treatment scale-up from 2019 required to achieve WHO targets with varying prioritization scenarios, with/without opiate substitution therapy scale-up (to 40% among people who inject drugs [PWID]).
RESULTS
RESULTS
We estimated 3855 (95% confidence interval: 2635-5446) chronically HCV-infected individuals with a history of IDU and 148 (87-284) incident HCV cases in Singapore in 2019. Reaching the HCV incidence target requires 272 (187-384) treatments in 2019, totaling 2444 (1683-3452) across 2019-2030. By prioritizing PWID or PWID and cirrhotics, 60% or 30% fewer treatments are required, respectively, whereas the target cannot be achieved with cirrhosis prioritization. Opiate substitution therapy scale-up reduces treatments required by 21-24%. Achieving both WHO targets requires treating 631 (359-1047) in 2019, totaling 3816 (2664-5423) across 2019-2030.
CONCLUSIONS
CONCLUSIONS
Hepatitis C virus elimination is achievable in Singapore but even with declining IDU requires immediate treatment scale-up among PWID. Harm reduction provision reduces treatments required and provides additional benefits.
Identifiants
pubmed: 32777859
doi: 10.1111/jgh.15211
pmc: PMC8174139
mid: NIHMS1706943
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1110-1117Subventions
Organisme : National Institute of Allergy and Infectious Diseases
Organisme : NIH HHS
ID : AI036214
Pays : United States
Organisme : NIH HHS
ID : AI131971-01
Pays : United States
Organisme : NIAID NIH HHS
ID : R21 AI131971
Pays : United States
Organisme : Gilead Sciences
Organisme : NIAID NIH HHS
ID : R01 AI147490
Pays : United States
Organisme : NIDA NIH HHS
ID : R01AI147490
Pays : United States
Organisme : NIH HHS
ID : P30 AI036214
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI036214
Pays : United States
Organisme : University of California San Diego Center for AIDS Research
Informations de copyright
© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Southeast Asian J Trop Med Public Health. 1993;24 Suppl 1:127-9
pubmed: 7533946
Singapore Med J. 2019 Jan;60(1):34-39
pubmed: 29926111
J Public Health Med. 1995 Dec;17(4):387-91
pubmed: 8639336
J Viral Hepat. 2006 Jan;13(1):34-41
pubmed: 16364080
Addiction. 2009 Aug;104(8):1363-72
pubmed: 19549053
Singapore Med J. 2020 Jul 30;:
pubmed: 32729280
Cochrane Database Syst Rev. 2017 Sep 18;9:CD012021
pubmed: 28922449
J Subst Abuse Treat. 2010 Jul;39(1):22-31
pubmed: 20418051
Transplant Proc. 2018 Dec;50(10):3564-3570
pubmed: 30577239
Hepatobiliary Pancreat Dis Int. 2019 Apr;18(2):143-148
pubmed: 30558838
J Viral Hepat. 2019 Dec;26(12):1388-1403
pubmed: 31392812
Clin Infect Dis. 2013 Aug;57 Suppl 2:S39-45
pubmed: 23884064
Sex Transm Infect. 2019 Dec;95(8):602-607
pubmed: 31073092
Singapore Med J. 2006 Nov;47(11):919-21
pubmed: 17075655
Liver Int. 2016 Jan;36 Suppl 1:67-71
pubmed: 26725900
BMJ. 2010 Oct 26;341:c5475
pubmed: 20978062
Clin Infect Dis. 2018 Oct 30;67(10):1477-1492
pubmed: 30215672
Singapore Med J. 2007 Jun;48(6):504-8
pubmed: 17538746
J Virus Erad. 2017 Jul 1;3(3):117-123
pubmed: 28758018
Hepatology. 2014 Jul;60(1):98-105
pubmed: 24615981
Lancet. 2019 Nov 2;394(10209):1652-1667
pubmed: 31668409
J Viral Hepat. 2011 Nov;18(11):745-59
pubmed: 21992794
Hepatology. 2013 Nov;58(5):1598-609
pubmed: 23553643
Int J Epidemiol. 2018 Apr 1;47(2):550-560
pubmed: 29309592
Lancet. 2016 Sep 10;388(10049):1081-1088
pubmed: 27394647
J Gastroenterol Hepatol. 2017 Jan;32(1):229-236
pubmed: 27197716
Antiviral Res. 2014 Jul;107:23-30
pubmed: 24726738
JGH Open. 2019 Feb 08;3(3):210-216
pubmed: 31276038