Curbing the hepatitis C virus epidemic in Pakistan

The impact of scaling up treatment and prevention for achieving elimination

Aaron G. Lim, Huma Qureshi, Hassan Mahmood, Saeed Hamid, Charlotte F. Davies, Adam Trickey, Nancy Ellen Glass, Quaid Saeed, Hannah Fraser, Josephine GWalker, Christinah Mukandavire, Matthew Hickman, Natasha K. Martin, Margaret T. May, Francisco Averhoff, Peter Vickerman

Research output: Contribution to journalArticle

Abstract

Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve theWHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ~150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.

Original languageEnglish (US)
Pages (from-to)550-560
Number of pages11
JournalInternational Journal of Epidemiology
Volume47
Issue number2
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

Fingerprint

Pakistan
Hepacivirus
Therapeutics
Antiviral Agents
Incidence
Expert Testimony
Blood Donors
Hepatitis
Fibrosis

Keywords

  • Direct-acting antivirals
  • Incidence
  • LMIC
  • Mathematical model
  • Mortality
  • Prevention

ASJC Scopus subject areas

  • Epidemiology

Cite this

Curbing the hepatitis C virus epidemic in Pakistan : The impact of scaling up treatment and prevention for achieving elimination. / Lim, Aaron G.; Qureshi, Huma; Mahmood, Hassan; Hamid, Saeed; Davies, Charlotte F.; Trickey, Adam; Glass, Nancy Ellen; Saeed, Quaid; Fraser, Hannah; GWalker, Josephine; Mukandavire, Christinah; Hickman, Matthew; Martin, Natasha K.; May, Margaret T.; Averhoff, Francisco; Vickerman, Peter.

In: International Journal of Epidemiology, Vol. 47, No. 2, 01.04.2018, p. 550-560.

Research output: Contribution to journalArticle

Lim, AG, Qureshi, H, Mahmood, H, Hamid, S, Davies, CF, Trickey, A, Glass, NE, Saeed, Q, Fraser, H, GWalker, J, Mukandavire, C, Hickman, M, Martin, NK, May, MT, Averhoff, F & Vickerman, P 2018, 'Curbing the hepatitis C virus epidemic in Pakistan: The impact of scaling up treatment and prevention for achieving elimination', International Journal of Epidemiology, vol. 47, no. 2, pp. 550-560. https://doi.org/10.1093/IJE/DYX270
Lim, Aaron G. ; Qureshi, Huma ; Mahmood, Hassan ; Hamid, Saeed ; Davies, Charlotte F. ; Trickey, Adam ; Glass, Nancy Ellen ; Saeed, Quaid ; Fraser, Hannah ; GWalker, Josephine ; Mukandavire, Christinah ; Hickman, Matthew ; Martin, Natasha K. ; May, Margaret T. ; Averhoff, Francisco ; Vickerman, Peter. / Curbing the hepatitis C virus epidemic in Pakistan : The impact of scaling up treatment and prevention for achieving elimination. In: International Journal of Epidemiology. 2018 ; Vol. 47, No. 2. pp. 550-560.
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abstract = "Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve theWHO HCV elimination target of reducing HCV incidence by 80{\%} and HCV-related mortality by 65{\%} by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ~150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9{\%} to 5.1{\%}, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80{\%} treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.",
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AU - Lim, Aaron G.

AU - Qureshi, Huma

AU - Mahmood, Hassan

AU - Hamid, Saeed

AU - Davies, Charlotte F.

AU - Trickey, Adam

AU - Glass, Nancy Ellen

AU - Saeed, Quaid

AU - Fraser, Hannah

AU - GWalker, Josephine

AU - Mukandavire, Christinah

AU - Hickman, Matthew

AU - Martin, Natasha K.

AU - May, Margaret T.

AU - Averhoff, Francisco

AU - Vickerman, Peter

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N2 - Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve theWHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ~150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.

AB - Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve theWHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ~150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.

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