Hepatitis C virus (HCV)-related deaths now exceed HIV-related deaths in the US. Throughout the world, HCV is hyperendemic in people who inject drugs (PWID). New outbreaks of acute HCV infection are unfolding in HIV-positive men who have sex with men (MSM) and in 15-24 year olds who have transitioned from abuse of prescription opioids to illicit opiate injection. In patients with chronic HCV infection, 20-25% wil develop liver disease which may manifest as cirrhosis, liver failure or hepatocellular carcinoma (HCC). The prognosis for HCC is extremely poor, and HCV is the chief etiologic agent for this type of cancer. Recent discoveries in HCV prevention and treatment provide a great opportunity to reverse the trend toward increasing rates of HCV, HCV/HIV co-infection, and HCC. This study will use the methods of Implementation Science - research synthesis, mathematical modeling and simulation, and comparative effectiveness analyses - to determine how best to constitute a portfolio of interventions for the prevention and control of HCV and its consequences while taking into limited resources and underlying epidemiologic and social network features account. A dissemination plan will make extensive use of technology, including social media, and guidance from key stakeholders. These are our specific aims: 1. Synthesize evidence characterizing a) transition from misuse of prescription opioids to drug injection, b) HCV epidemiology and prevention for PWID and HIV+ MSM, and c) progression and treatment of HCV disease in these two groups, to derive best estimates to populate our HCV natural history and transmission models. 2. Use agent-based modeling to estimate the effects of scale-up of individual and combined prevention- and treatment-related interventions on HCV transmission and natural history in PWID and HIV+MSM. 3. Determine the combination of interventions for particular budget and epidemiologic scenarios that a) minimizes acute and chronic HCV infections, including HIV/HCV co-infection, b) prevents the greatest number of cases of HCV-related HCC and other serious sequelae, c) maximizes life expectancy and quality- adjusted life expectancy and d) reduces health disparities. 4. In collaboration with our Dissemination Advisory Board, apply an integrated knowledge-exchange approach to providing our target audiences (policymakers, public health and harm reduction practice communities, PWID and HIV+MSM) with the knowledge and tools to implement evidence-based HCV control strategies or reduce personal risk of infection and its consequences. The broad objective of this study is to provide an evidence base to guide allocation of scarce public resources in the US and other countries where HCV is principally transmitted among PWID. This will be accomplished by synthesizing, modeling and translating very recent developments in HCV epidemiology, prevention and treatment into practical tools to optimize population health.
Statement The goal of this study is to help decision makers improve population health by providing guidance on the most effective set of interventions to control hepatitis C virus (HCV) infection in people who inject drugs and HIV- positive men who have sex with men. In the US, HCV is the main causal factor in hepatocellular carcinoma which has a very poor prognosis, and HCV-related deaths now exceed deaths related to HIV. This research will synthesize evidence as to the effectiveness of different intervention strategies in terms of both individual benefit (preventing HCV infections in these populations, reducing HCC and other consequences of HCV), and in terms of societal benefit (reducing health care costs and impact on life expectancy).
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|Khan, Bilal; Duncan, Ian; Saad, Mohamad et al. (2018) Combination interventions for Hepatitis C and Cirrhosis reduction among people who inject drugs: An agent-based, networked population simulation experiment. PLoS One 13:e0206356|
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|Platt, Lucy; Minozzi, Silvia; Reed, Jennifer et al. (2017) Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev 9:CD012021|
|Jordan, Ashly E; Perlman, David C; Reed, Jennifer et al. (2017) Patterns and Gaps Identified in a Systematic Review of the Hepatitis C Virus Care Continuum in Studies among People Who Use Drugs. Front Public Health 5:348|
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|Jordan, Ashly E; Blackburn, Natalie A; Des Jarlais, Don C et al. (2017) Past-year prevalence of prescription opioid misuse among those 11 to 30years of age in the United States: A systematic review and meta-analysis. J Subst Abuse Treat 77:31-37|
|Reed, Jennifer R; Jordan, Ashly E; Perlman, David C et al. (2016) The HCV care continuum among people who use drugs: protocol for a systematic review and meta-analysis. Syst Rev 5:110|
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