The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Article Dans Une Revue BMC Infectious Diseases Année : 2017

The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study

Résumé

AbstractBackgroundHCV transmission remains high in people who inject drugs (PWID) in Montréal. New direct-acting antivirals (DAAs), highly effective and more tolerable than previous regimens, make a “Treatment as Prevention” (TasP) strategy more feasible. This study assesses how improvements in the cascade of care could impact hepatitis C burden among PWID in Montréal.MethodsWe used a dynamic model to simulate HCV incidence and prevalence after 10 years, and cirrhosis complications after 10 and 40 years. Eight scenarios of improved cascade of care were examined.ResultsUsing a baseline incidence and prevalence of 22.1/100 person-years (PY) and 53.1%, implementing the current cascade of care using DAAs would lead to HCV incidence and prevalence estimates at 10 years of 9.4/100PY and 55.8%, respectively. Increasing the treatment initiation rate from 5%/year initially to 20%/year resulted in large decreases in incidence (6.4/100PY), prevalence (36.6%), and cirrhosis complications (−18%/-37% after 10/40 years). When restricting treatment to fibrosis level ≥ F2 instead of F0 (reference scenario), such decreases in HCV occurrence were unreachable. Improving the whole cascade of care led to the greatest effect by halving both the incidence and prevalence at 10 years, and the number of cirrhosis complications after 40 years.ConclusionsThe current level of treatment access in Montréal is limiting a massive decrease in hepatitis C burden among PWID. A substantial treatment scale-up, regardless of fibrosis level, is necessary. While improving the rest of the cascade of care is necessary to optimize a TasP strategy and control the HCV epidemic, a treatment scale-up is first needed.
Fichier principal
Vignette du fichier
12879_2017_Article_2256.pdf (720.28 Ko) Télécharger le fichier
Origine : Publication financée par une institution
Loading...

Dates et versions

inserm-01473399 , version 1 (21-02-2017)

Identifiants

Citer

Anthony Cousien, Pascale Leclerc, Carole Morissette, Julie Bruneau, Élise Roy, et al.. The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study. BMC Infectious Diseases, 2017, 17 (1), pp.162. ⟨10.1186/s12879-017-2256-5⟩. ⟨inserm-01473399⟩
391 Consultations
256 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More