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Modelling the Impact of Targeted Interventions on the HCV Epidemic in Pakistan
The Road to HCV Elimination
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Reported by Jules Levin
EASL 2017 April 19-23 Amsterdam Netherlands
Aaron G. Lim1, Huma Qureshi2, Charlotte F. Davies1, Saeed Hamid3, Adam Trickey1, Nancy Glass4, Hassan Mahmood5, Quaid Saeed6, Hannah Fraser1,
Christinah Mukandavire1, Matthew Hickman1, Natasha K. Martin1
7, Margaret May1, Francisco Averhoff4, Peter Vickerman1
1 School of Social and Community Medicine, University of Bristol, UK; 2 Pakistan Medical Research Council, Islamabad, Pakistan; 3 Aga Khan University, Karachi, Pakistan;
4 Division of Viral Hepatitis, 5 TEPHINET, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 6 National AIDS Control Programme, Islamabad, Pakistan; 7 Division of Global Public Health, University of California San Diego, USA
Program Abstract
Background and Aims: Pakistan harbours the second-largest number of hepatitis C virus (HCV) infections in the world. Transmission is associated with healthcare and community exposures as well as injecting drug use. We use modelling to project the epidemic burden in Pakistan, and treatment requirements with new direct acting antivirals (DAA) to achieve the World Health Organisation HCV elimination targets.
Methods:A HCV transmission model capturing the increasing population and demographics in Pakistan was developed, and calibrated using chronic HCV prevalence estimates from a national survey conducted in 2007 (3.6%) and surveys among people who inject drugs (56-69%). Blood donor HCV prevalence data over time was used to estimate changes in HCV prevalence in the general population over time. The model projects HCV burden through 2030, the contribution of selected risk factors on transmission, and estimates the number of DAA treatments coupled with interventions to prevent transmission for achieving an 80% reduction in incidence and a 65% reduction in HCV disease mortality by 2030.
Results: From 2016 to 2030, the model projected an increase in population size and chronic prevalence (3.9% to 5.1%) in Pakistan if treatment and prevention interventions are not scaled up, representing an increase from 7.5 to 12.6 million prevalent infections and 0.7 to 1.1 million incident infections annually. About 14% of new infections over this period will be due to injecting drug use, and a further 29% due to high medical and community risk factors. To reach the WHO elimination targets for HCV by 2030, 900,000 annual treatments will be needed if there is no prevention scale-up or targeting of treatment; decreasing to 750,000 if 80% of cirrhotics are preferentially treated annually and PWID are treated at double the rate of non-PWID, and 500,000 if overall transmission risk in all groups is also halved.
Conclusions: Without scaling up prevention and HCV treatment interventions, the HCV burden in Pakistan is likely to increase markedly by 2030, reaching nearly 10% of the current global HCV burden. Substantial scale-up of prevention and treatment interventions is needed to bring down the massive HCV epidemic in Pakistan.
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