Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high‐prevalence setting?

Aims To project the impact of scaling up oral antiviral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programs to achieve specific targets and to examine whether hepatitis C viruse (HCV) elimination among PWID is possible in this high prevalence setting. Design A dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for reinfection following treatment. Setting/Participants The population of 8,300 PWID in Athens Metropolitan area Measurements Reduction in HCV prevalence and incidence in 2030 compared with 2016. Findings Moderate expansion of HCV treatment (treating 4%-8% of PWID/year), with simultaneous increase of 2%/year in harm reduction coverage (from 44% to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46%-90% in 2030, compared with 2016. CHC prevalence would reduce below 10% within the next 4-5 years if annual HCV treatment numbers were increased up to 16%-20% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates. Conclusions Based on theoretical model projections, scaled-up hepatitis C virus (HCV) treatment and harm reduction interventions could achieve major reductions in HCV incidence and prevalence among people who inject drugs (PWID) in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4-5 years by increasing treatment to more than 16% of PWID per year combined with moderate increases in harm reduction coverage.