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Modelling the potential prevention benefits of a treat-all hepatitis C treatment strategy at global, regional, and country levels: a modelling study.

  • Trickey, Adam1, 2
  • Fraser, Hannah1
  • Lim, Aaron G1
  • Walker, Josephine G1
  • Peacock, Amy3
  • Colledge, Samantha3
  • Leung, Janni3, 4, 5
  • Grebely, Jason5, 6
  • Larney, Sarah3
  • Martin, Natasha K1, 7
  • Degenhardt, Louisa3
  • Hickman, Matthew1, 2
  • May, Margaret T1, 2, 8
  • Vickerman, Peter1, 2
  • 1 Population Health Sciences, University of Bristol, Bristol, UK.
  • 2 National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK.
  • 3 National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia. , (Australia)
  • 4 Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia. , (Australia)
  • 5 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States. , (United States)
  • 6 The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. , (Australia)
  • 7 Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.
  • 8 National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Published Article
Journal of Viral Hepatitis
Wiley (Blackwell Publishing)
Publication Date
Aug 07, 2019
DOI: 10.1111/jvh.13187
PMID: 31392812


The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional, and global-levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN datasets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20-years. Linear regression identified associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20-years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35, and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth-rate, and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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