TY - JOUR
T1 - Curbing the hepatitis C virus epidemic in Pakistan
T2 - The impact of scaling up treatment and prevention for achieving elimination
AU - Lim, Aaron G.
AU - Qureshi, Huma
AU - Mahmood, Hassan
AU - Hamid, Saeed
AU - Davies, Charlotte F.
AU - Trickey, Adam
AU - Glass, Nancy
AU - Saeed, Quaid
AU - Fraser, Hannah
AU - GWalker, Josephine
AU - Mukandavire, Christinah
AU - Hickman, Matthew
AU - Martin, Natasha K.
AU - May, Margaret T.
AU - Averhoff, Francisco
AU - Vickerman, Peter
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2018/4
Y1 - 2018/4
N2 - Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve theWHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ~150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.
AB - Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve theWHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ~150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.
KW - Direct-acting antivirals
KW - Incidence
KW - LMIC
KW - Mathematical model
KW - Mortality
KW - Prevention
UR - http://www.scopus.com/inward/record.url?scp=85051852286&partnerID=8YFLogxK
U2 - 10.1093/ije/dyx270
DO - 10.1093/ije/dyx270
M3 - Article
C2 - 29309592
AN - SCOPUS:85051852286
SN - 0300-5771
VL - 47
SP - 550
EP - 560
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
IS - 2
ER -