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Treatment of hepatitis c as prevention: a modeling case study in Vietnam

Abstract:

Background: Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50–90% of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored.

Methods and Findings: In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75% of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50% coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values.

Conclusions: In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission and prevalence.

Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1371/journal.pone.0034548

Authors


More by this author
Institution:
University of Oxford
Division:
MSD
Department:
NDM
Sub department:
Tropical Medicine
Oxford college:
Wadham College
Role:
Author
ORCID:
0000-0002-6523-185X


More from this funder
Grant:
089275
089275/Z/09/Z


Publisher:
Public Library of Science
Journal:
PLoS ONE More from this journal
Volume:
7
Issue:
4
Pages:
e34548
Publication date:
2012-04-12
Acceptance date:
2012-03-06
DOI:
EISSN:
1932-6203
Pmid:
22511949


Language:
English
Keywords:
Pubs id:
pubs:342720
UUID:
uuid:c66c1bdf-d87c-41ee-93f7-e99422922716
Local pid:
pubs:342720
Source identifiers:
342720
Deposit date:
2019-02-05

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