Modeling the Impacts of Prevention and Treatment Interventions on Hepatitis C Among People Who Inject Drugs in China

Plain Language SummaryChina has the largest number of people living with the hepatitis C virus. The prevalence of hepatitis C among people who inject drugs is high at 40-50%, significantly higher than the prevalence among other high-risk groups. Preventing the transmission of hepatitis C among people who inject drugs is essential to avoid future liver diseases. We used a mathematical model to evaluate the impacts of different intervention strategies on the incidence, prevalence and mortality of hepatitis C among people who inject drugs in China by 2030. We found that scaled-up hepatitis C screening and treatment integrated with harm reduction programs demonstrated the most substantial reduction in the burden of hepatitis C; specifically, the incidence of hepatitis C in 2030 is reduced by 81.42% and hepatitis-C-related deaths are reduced by 91.94%. Increasing harm reduction program coverage among people who inject drugs has a greater impact in terms of reducing the burden of hepatitis C virus compared with enhanced linkage to care or test frequency alone. Substantial improvements in both testing and treatment integrated with existing harm reduction programs are essential to achieve the goal of eliminating hepatitis C in China by 2030. IntroductionInjection drug use is the main transmission route of hepatitis C virus (HCV) in China. The prevalence of HCV remains high at 40-50% among people who inject drugs (PWID). We developed a mathematical model to predict the impacts of different HCV intervention strategies on the HCV burden in Chinese PWID by 2030.MethodsWe developed a dynamic deterministic mathematical model to simulate the transmission of HCV among PWID in China between 2016 and 2030, using domestic data based on the real cascade of HCV care. We considered various intervention scenarios, including treatment regimens, harm reduction program (HRP) coverage, enhanced testing and referral for treatment.ResultsHCV incidence will exhibit a gradual but slow declining trend from 12,970 in 2016 to 11,761 in 2030 based on current screening and treatment practices among PWID (scenario 1). Scaled-up HCV screening and treatment integrated with HRPs (scenario 8) demonstrated the most substantial reduction in HCV burden, being the only intervention scenario that could achieve the World Health Organization's (WHO's) HCV elimination target. Specifically, the HCV incidence in 2030 is projected to be reduced by 81.42%, and HCV-related deaths are projected to be reduced by 91.94%.ConclusionOur study indicates that achieving WHO elimination targets is an extremely challenging goal that requires substantial improvements in HCV testing and treatment among PWID (scenario S8). The findings suggest that coordinated improvements in testing, treatment, and harm reduction programs could greatly reduce the HCV burden among PWID in China, and urgent policy changes are needed to integrate HCV testing and treatment into existing HRPs.