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Achieving hepatitis C elimination in Europe – To treatment scale-up and beyond

  • M. Hellard
    Correspondence
    Corresponding author. Address: Burnet Institute, Melbourne, VIC 3004, Australia. Tel.: +61 3 9282 2163.
    Affiliations
    Burnet Institute, Melbourne, VIC 3004, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia

    Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC 3004, Australia
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  • N. Scott
    Affiliations
    Burnet Institute, Melbourne, VIC 3004, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
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  • R. Sacks-Davis
    Affiliations
    Burnet Institute, Melbourne, VIC 3004, Australia

    Department of Medicine, University of Melbourne, Parkville, VIC 3010
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  • A. Pedrana
    Affiliations
    Burnet Institute, Melbourne, VIC 3004, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
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Published:December 09, 2017DOI:https://doi.org/10.1016/j.jhep.2017.12.004
      Fraser and colleagues
      • Fraser H.
      • Martin N.K.
      • Brummer-Korvenkontio H.
      • Carrieri P.
      • Dalgard O.
      • Dillon J.
      • et al.
      Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe.
      have used a mathematical model to show that for many European countries, using direct-acting antiviral (DAA) therapy to treat hepatitis C infection is unlikely to have a substantive impact on hepatitis C incidence and prevalence among people who inject drugs (PWID) unless treatment rates are increased substantively beyond current levels. Their model explicitly accounts for the opioid substitution therapy (OST) and needle and syringe program (NSP) coverage of each setting, which is important not only because of the proven effectiveness of the programs in reducing hepatitis C transmission,
      • Turner K.M.
      • Hutchinson S.
      • Vickerman P.
      • Hope V.
      • Craine N.
      • Palmateer N.
      • et al.
      The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence.
      but because it allows the authors to quantify the benefits of prevention interventions in isolation and when combined with treatment scale-up. Their findings reiterate the importance of high prevention coverage (OST and NSP) as a primary method of reducing incidence and prevalence and also as a method of enhancing the epidemiological impact of treatment, through treatment-as-prevention.

      Linked Article

      • Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe
        Journal of HepatologyVol. 68Issue 3
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          Chronic hepatitis C virus (HCV) infection is a leading cause of liver disease and morbidity, causing more deaths than HIV in the United States and other high-income countries.1–4 Preventing HCV transmission among people who inject drugs (PWID) is critical for averting future liver disease in Europe and elsewhere5 and new HCV infections in this group.6 Primary prevention through opioid substitution therapy (OST) and high-coverage needle and syringe programmes (NSPs) can reduce HCV transmission among PWID7,8 and averts new HCV infections,9 but substantial reductions in HCV prevalence are unlikely to be achieved without scaling-up HCV treatment.
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