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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA031059-03S1
Application #
8862651
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Kahana, Shoshana Y
Project Start
2012-06-15
Project End
2016-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
3
Fiscal Year
2014
Total Cost
$89,642
Indirect Cost
$37,975
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118
Schackman, Bruce R; Gutkind, Sarah; Morgan, Jake R et al. (2018) Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs. Drug Alcohol Depend 185:411-420
Morgan, Jake R; Kim, Arthur Y; Naggie, Susanna et al. (2018) The Effect of Shorter Treatment Regimens for Hepatitis C on Population Health and Under Fixed Budgets. Open Forum Infect Dis 5:ofx267
Barocas, Joshua A; White, Laura F; Wang, Jianing et al. (2018) Estimated Prevalence of Opioid Use Disorder in Massachusetts, 2011-2015: A Capture-Recapture Analysis. Am J Public Health 108:1675-1681
Linas, Benjamin P; Nolen, Shayla (2018) A Guide to the Economics of Hepatitis C Virus Cure in 2017. Infect Dis Clin North Am 32:447-459
Morgan, Jake R; Schackman, Bruce R; Leff, Jared A et al. (2018) Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population. J Subst Abuse Treat 85:90-96
Rodriguez, Carla V; Rubenstein, Kevin B; Linas, Benjamin et al. (2018) Increasing hepatitis C screening in a large integrated health system: science and policy in concert. Am J Manag Care 24:e134-e140
Schechter-Perkins, Elissa M; Miller, Nancy S; Hall, Jon et al. (2018) Implementation and Preliminary Results of an Emergency Department Nontargeted, Opt-out Hepatitis C Virus Screening Program. Acad Emerg Med :
Rajasingham, Radha; Pollock, Nira R; Linas, Benjamin P (2017) The Cost-effectiveness of a Point-of-Care Paper Transaminase Test for Monitoring Treatment of HIV/TB Co-Infected Persons. Open Forum Infect Dis 4:ofx194
Assoumou, Sabrina A; Huang, Wei; Young, Kraig et al. (2017) Real-world Outcomes of Hepatitis C Treatment during the Interferon-free Era at an Urban Safety-net Hospital. J Health Care Poor Underserved 28:1333-1344
Barocas, Joshua A; Wang, Jianing; White, Laura F et al. (2017) Hepatitis C Testing Increased Among Baby Boomers Following The 2012 Change To CDC Testing Recommendations. Health Aff (Millwood) 36:2142-2150

Showing the most recent 10 out of 34 publications