Potential Impact of Frequent Testing for Hepatitis C Virus Among People Who Inject Drugs Toward Hepatitis C Elimination in the United States

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND: Current hepatitis C virus (HCV) guidelines recommend testing at least once in a lifetime for all adults and periodic testing for people with ongoing risk factors. However, the testing frequency required for these populations including people who inject drugs (PWID) remains unknown. METHODS: We developed a dynamic network model to simulate HCV transmission among PWID via sharing of injection equipment. We simulated different testing frequencies among PWID, paired with a treatment cascade of direct-acting antiviral therapy, and compared their impact on HCV infection prevalence, incidence, and HCV-related deaths over 10 years. We conducted sensitivity analyses on key parameters and assumptions. RESULTS: In the main analysis, testing on average once per 6 months reduced HCV infection prevalence, incidence, and HCV-related deaths by up to 45%, 37%, and 42%, respectively. In the sensitivity analyses, increased coverage (access and utilization) had the greatest impact on all three outcomes, and reinfection risk after cure had a substantial impact on incidence. Lower transmission risk, higher cessation rate of injection, and longer partnership duration decreased the 3 outcomes with or without HCV testing. CONCLUSIONS: Frequent HCV testing with treatment had a substantial impact on hepatitis C elimination outcomes. However, it alone in the context of current continuum of care among PWID is unlikely to be sufficient to achieving elimination. Improving access to and utilization of hepatitis C care and harm-reduction services among PWID are crucial to achieving elimination.