HCV-related liver disease is a leading cause of mortality among HIV-infected individuals in the U.S. Current therapy for HCV infection has limited efficacy, but the first HCV protease inhibitors were recently approved by the FDA and have substantially improved treatment outcomes. Many HCV-infected individuals, however, are not aware that they are infected. Further, as a result of limited treatment uptake and high rates of loss to follow- up, few HIV/HCV co-infected patients ever initiate HCV therapy. Recognizing the public health challenge represented by HCV, the Institute of Medicine and American Association for the Study of Liver Diseases have called for studies to identify the best strategies for HCV screening and care delivery. We propose to build a mathematical model of HIV/HCV co-infection to generate urgently-needed evidence that will inform screening and treatment guidelines and improve patient outcomes. The three specific aims are: 1. To develop and validate a Monte Carlo simulation model of HIV/HCV co-infection that includes HCV and HIV screening, linkage to and retention in care, and treatment. 2. To use the model to conduct and disseminate a series of analyses that will develop the evidence needed to inform clinical guidelines for identifying and managing HIV/HCV co-infection in the era of directly acting antiviral therapies against HCV. 3. To conduct policy analyses that will develop priorities for improving access to HCV treatment and project the budgetary impact of widely-available directly acting therapies against HCV. The proposed specific aims will answer critical questions about the best strategies for identifying and treating HCV and HIV/HCV co-infection. The project will develop a durable platform poised to be the premier tool for rapidly conducting rigorous analyses of the comparative-effectiveness and cost-effectiveness of strategies for improving HCV and HIV/HCV care in the new era of effective HCV therapy.

Public Health Relevance

Hepatitis C Virus-related (HCV) liver disease is a leading cause of mortality in HIV-infected people in the U.S. and a particular health threat for vulnerable populations, such as current and former drug users. The Institute of Medicine recently recommended expanding screening for HCV and improving the availability of HCV treatment in vulnerable populations. This project uses simulation modeling methods to generate the evidence needed to establish best practices for identifying HCV infection and managing HIV/HCV co-infection.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Kahana, Shoshana Y
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Boston Medical Center
United States
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Linas, Benjamin P; Morgan, Jake R; Pho, Mai T et al. (2017) Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1. Open Forum Infect Dis 4:ofw266
Morgan, Jake R; Servidone, Maria; Easterbrook, Philippa et al. (2017) Economic evaluation of HCV testing approaches in low and middle income countries. BMC Infect Dis 17:697
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Barocas, Joshua A; Linas, Benjamin P (2017) Editorial Commentary: Decision Science at Work: The Case of Hepatitis C Virus Postexposure Prophylaxis. Clin Infect Dis 64:100-101
Barocas, Joshua A; Beiser, Marguerite; León, Casey et al. (2017) Experience and Outcomes of Hepatitis C Treatment in a Cohort of Homeless and Marginally Housed Adults. JAMA Intern Med 177:880-882
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Carey, Katelyn J; Huang, Wei; Linas, Benjamin P et al. (2016) Hepatitis C Virus Testing and Treatment Among Persons Receiving Buprenorphine in an Office-Based Program for Opioid Use Disorders. J Subst Abuse Treat 66:54-9
Linas, Benjamin P (2016) Understanding Cost and Value in Hepatitis C Therapy. Top Antivir Med 24:93-97
Freiman, J Morgan; Tran, Trang M; Schumacher, Samuel G et al. (2016) Hepatitis C Core Antigen Testing for Diagnosis of Hepatitis C Virus Infection: A Systematic Review and Meta-analysis. Ann Intern Med 165:345-55
Barocas, Joshua A; Linas, Benjamin P; Kim, Arthur Y et al. (2016) Acceptability of Rapid Point-of-Care Hepatitis C Tests Among People Who Inject Drugs and Utilize Syringe-Exchange Programs. Open Forum Infect Dis 3:ofw075

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