Hepatitis C virus treatment for prevention among people who inject drugs: Modeling treatment scale-up in the age of direct-acting antivirals


  • The views expressed in this article are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health.

  • This work was produced under the terms of the postdoctoral research training fellowship (to N. K. M.) issued by the National Institute for Health Research (NIHR). P. V. was supported by Medical Research Council New Investigator Award G0801627. J. G. was supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowship. M. Hellard was supported by an NHMRC Project Grant and the Victorian Operational Infrastructure Support Program. V. D. L. was supported by a National Institute on Drug Abuse Michael Smith Foundation for Health Research Scholar Award. G. J. D. was supported by a NHMRC Practitioner Research Fellowship. The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, University of New South Wales. M. Hickman was supported by the NIHR School of Public Health Nationally Integrated Quantitative Understanding of Addiction Harm MRC addiction research cluster and The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding was also received from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council (grant RES-590-28-0005), the Medical Research Council, the Welsh Assembly Government, and the Wellcome Trust (grant WT087640MA) under the auspices of the UKCRC.

  • Potential conflict of interest: N. K. M. has received an honorarium for speaking at a conference sponsored by Janssen. J. G. owns stock in Gilead and is a member of an advisory board for Merck. S. J. H. has received honoraria for speaking at conferences sponsored by MSD and Janssen and consults for Janssen. G. R. F. has received funding from Roche, Novartis, Janssen, Gilead, Bristol-Meyers Squibb, Boehringer Ingelheim, Idenix, Abbott, and Merck for consultancy and lectures. D. J. G. is a member of advisory boards and undertakes consultancy for Merck and Janssen. G. J. D. is a consultant/advisor and has received research grants from Roche, Merck, Janssen, Gilead, Bristol-Myers Squibb, and Abbott.

  • See Editorial on Page 1523


Substantial reductions in hepatitis C virus (HCV) prevalence among people who inject drugs (PWID) cannot be achieved by harm reduction interventions such as needle exchange and opiate substitution therapy (OST) alone. Current HCV treatment is arduous and uptake is low, but new highly effective and tolerable interferon-free direct-acting antiviral (DAA) treatments could facilitate increased uptake. We projected the potential impact of DAA treatments on PWID HCV prevalence in three settings. A dynamic HCV transmission model was parameterized to three chronic HCV prevalence settings: Edinburgh, UK (25%); Melbourne, Australia (50%); and Vancouver, Canada (65%). Using realistic scenarios of future DAAs (90% sustained viral response, 12 weeks duration, available 2015), we projected the treatment rates required to reduce chronic HCV prevalence by half or three-quarters within 15 years. Current HCV treatment rates may have a minimal impact on prevalence in Melbourne and Vancouver (<2% relative reductions) but could reduce prevalence by 26% in 15 years in Edinburgh. Prevalence could halve within 15 years with treatment scale-up to 15, 40, or 76 per 1,000 PWID annually in Edinburgh, Melbourne, or Vancouver, respectively (2-, 13-, and 15-fold increases, respectively). Scale-up to 22, 54, or 98 per 1,000 PWID annually could reduce prevalence by three-quarters within 15 years. Less impact occurs with delayed scale-up, higher baseline prevalence, or shorter average injecting duration. Results are insensitive to risk heterogeneity or restricting treatment to PWID on OST. At existing HCV drug costs, halving chronic prevalence would require annual treatment budgets of US $3.2 million in Edinburgh and approximately $50 million in Melbourne and Vancouver. Conclusion: Interferon-free DAAs could enable increased HCV treatment uptake among PWID, which could have a major preventative impact. However, treatment costs may limit scale-up, and should be addressed. (Hepatology 2013;58:1598–1609)