+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model



Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model



Lancet 393(10178): 1319-1329



The revolution in hepatitis C virus (HCV) treatment through the development of direct-acting antivirals (DAAs) has generated international interest in the global elimination of the disease as a public health threat. In 2017, this led WHO to establish elimination targets for 2030. We evaluated the impact of public health interventions on the global HCV epidemic and investigated whether WHO's elimination targets could be met. We developed a dynamic transmission model of the global HCV epidemic, calibrated to 190 countries, which incorporates data on demography, people who inject drugs (PWID), current coverage of treatment and prevention programmes, natural history of the disease, HCV prevalence, and HCV-attributable mortality. We estimated the worldwide impact of scaling up interventions that reduce risk of transmission, improve access to treatment, and increase screening for HCV infection by considering six scenarios: no change made to existing levels of diagnosis or treatment; sequentially adding the following interventions: blood safety and infection control, PWID harm reduction, offering of DAAs at diagnosis, and outreach screening to increase the number diagnosed; and a scenario in which DAAs are not introduced (ie, treatment is only with pegylated interferon and oral ribavirin) to investigate the effect of DAA use. We explored the effect of varying the coverage or impact of these interventions in sensitivity analyses and also assessed the impact on the global epidemic of removing certain key countries from the package of interventions. By 2030, interventions that reduce risk of transmission in the non-PWID population by 80% and increase coverage of harm reduction services to 40% of PWID could avert 14·1 million (95% credible interval 13·0-15·2) new infections. Offering DAAs at time of diagnosis in all countries could prevent 640 000 deaths (620 000-670 000) from cirrhosis and liver cancer. A comprehensive package of prevention, screening, and treatment interventions could avert 15·1 million (13·8-16·1) new infections and 1·5 million (1·4-1·6) cirrhosis and liver cancer deaths, corresponding to an 81% (78-82) reduction in incidence and a 61% (60-62) reduction in mortality compared with 2015 baseline. This reaches the WHO HCV incidence reduction target of 80% but is just short of the mortality reduction target of 65%, which could be reached by 2032. Reducing global burden depends upon success of prevention interventions, implemention of outreach screening, and progress made in key high-burden countries including China, India, and Pakistan. Further improvements in blood safety and infection control, expansion or creation of PWID harm reduction services, and extensive screening for HCV with concomitant treatment for all are necessary to reduce the burden of HCV. These findings should inform the ongoing global action to eliminate the HCV epidemic. Wellcome Trust.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 066446849

Download citation: RISBibTeXText

PMID: 30704789

DOI: 10.1016/s0140-6736(18)32277-3


Related references

Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination. International Journal of Epidemiology 47(2): 550-560, 2018

Hepatitis C elimination by 2030 through treatment and prevention: think global, act in local networks. Journal of Epidemiology and Community Health 70(12): 1151-1154, 2016

Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System. Medicina Clinica 148(6): 277-282, 2017

Mathematical modeling of hepatitis c virus (HCV) prevention among people who inject drugs: A review of the literature and insights for elimination strategies. Journal of Theoretical Biology 481: 194-201, 2019

A National Strategy for the Elimination of Viral Hepatitis Emphasizes Prevention, Screening, and Universal Treatment of Hepatitis C. Annals of Internal Medicine 166(12): 895-896, 2017

Global analysis of a mathematical model for Hepatitis C virus transmissions. Virus Research 217: 8, 2016

A mathematical model to estimate global hepatitis B disease burden and vaccination impact. International Journal of Epidemiology 34(6): 1329-1339, 2005

Towards elimination of hepatitis B and C in European Union and European Economic Area countries: monitoring the World Health Organization's global health sector strategy core indicators and scaling up key interventions. Euro Surveillance 22(9):, 2017

Micro-elimination - A path to global elimination of hepatitis C. Journal of Hepatology 67(4): 665-666, 2017

Mathematical model of the transformation of viral hepatitis into chronic disease. Preliminary results. I. Specification of global descriptive parameters of hepatic inflammation. Physiologie 15(3): 187-194, 1978

Consciousness: A Mathematical Treatment of the Global Neuronal Workspace Model. Acta Biotheoretica 54(2): 157-160, 2006

Integrating HIV, hepatitis B and syphilis screening and treatment through the Maternal, Newborn and Child Health platform to reach global elimination targets. Western Pacific Surveillance and Response Journal 8(4): 1-5, 2018

Estimated impact on birth weight of scaling up intermittent preventive treatment of malaria in pregnancy given sulphadoxine-pyrimethamine resistance in Africa: A mathematical model. Plos Medicine 14(2): E1002243, 2017

Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. Plos one 9(7): E103345, 2014

The global burden of viral hepatitis: better estimates to guide hepatitis elimination efforts. Lancet 388(10049): 1030-1031, 2016