Modelling the Impact of Interventions Targeting High-Risk Populations on the HCV Epidemic in Pakistan

Author: Lim AG, Qureshi H, Davies C, Hamid S, Trickey A, Glass N, Mahmood H, Saeed Q, Woodall H, Mukandavire C, Hickman M, Martin NK, May M, Averhoff F, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2016


Lim AG1, Qureshi H2, Davies C1, Hamid S3, Trickey A1, Glass N4, Mahmood H5, Saeed Q6, Woodall H1, Mukandavire C1, Hickman M1, Martin NK1,7, May M1, Averhoff F4, Vickerman P1

1School of Social and Community Medicine, University of Bristol, Bristol, UK

2Pakistan Health Research Council, Islamabad, Pakistan

3Aga Khan University, Karachi, Pakistan

4Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

5TEPHINET, Centers for Disease Control and Prevention, Atlanta, Georgia USA

6World Health Organization, Islamabad, Pakistan

7Division of Global Public Health, University of California San Diego, USA

Background: Chronic prevalence of hepatitis C (HCV) infection in Pakistan is estimated to be ~4%, with transmission primarily associated with healthcare, injecting drug use, and community exposures. We use modelling to project future HCV burden and the impact of targeted interventions.

Methods: A HCV transmission model capturing current population demographics in Pakistan was developed and calibrated using chronic HCV prevalence estimates from a national survey conducted in 2007 (3.6%) and amongst people who inject drugs (PWID, 56-69%). The model estimates HCV burden until 2030, and evaluates the impact of risk reduction and treatment interventions targeting the general population and high-risk groups including PWID.

Results: From 2015 to 2030, the model projected an increase in chronic HCV prevalence (4.0% to 5.2%) and incidence (3.6 to 4.7 per 1000 person-years (py)) in Pakistan without interventions, representing an increase from 8 to 13 million prevalent infections and from 0.7 to 1.1 million incident infections annually. About 15% of new infections over the next 15 years will be attributable to injecting drug use. Reducing PWID-related HCV transmission risk by 50% can avert over 820,000 new infections from 2015 to 2030. Treating overall at 5.0% per year (~370,000/year) could decrease prevalence to 2.9% by 2030 and incidence to 2.8/1000py, with 520 new infections averted per 1000 treatments (IA/1000T). Utilising the same number of treatments, targeting PWIDs at 10 times the rate as the general population can reduce incidence to 2.5/1000py and achieve 610 IA/1000T. Combining targeted treatment with reduction in PWID-related transmission risk by 50% could achieve an even greater impact of 840 IA/1000T.

Conclusion: Model projections suggest treatment interventions targeting high-risk HCV transmission groups, such as PWID, can have substantial impact by averting a greater number of infections per treatment, an especially important consideration in resource-limited settings with high HCV burden such as Pakistan.

Disclosure of Interest Statement: Nothing to disclose.

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