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Feasibility of hepatitis C elimination by screening and treatment alone in high-income countries
Feng Tian1, Farinaz Forouzannia1, Zeny Feng2
1School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.
Insights
Current hepatitis C screening in Canada is insufficient to meet WHO elimination goals. Enhanced screening and harm reduction are crucial for reducing new chronic hepatitis C (CHC) cases and mortality by 2030.
Area of Science:
- Hepatology and epidemiology
- Public health modeling
- Infectious disease control
Background:
- Chronic hepatitis C (CHC) remains a significant public health issue globally, despite effective treatments.
- Declining treatment rates and the COVID-19 pandemic threaten the World Health Organization's (WHO) 2030 hepatitis C virus (HCV) elimination targets.
- Canada's reliance on risk-based screening for HCV case identification poses challenges for achieving elimination goals.
Purpose of the Study:
- To model the impact of CHC in Canada, a high-income country with immigration from HCV-endemic regions.
- To evaluate the effectiveness of various prevention strategies, including harm reduction, screening, and treatment.
- To assess the feasibility of meeting WHO HCV elimination targets by 2030 under current and scaled-up interventions.
Main Methods:
- Development of an agent-based model to simulate the HCV epidemic in Canada.
- Calibration of model parameters using existing literature and historical HCV data.
- Performance of sensitivity analyses to evaluate the impact of key variables on model outcomes.
Main Results:
- Under current risk-based screening, CHC incidence is projected to decrease by only 11.1% by 2030.
- Significant reductions are predicted for CHC-induced decompensated cirrhosis (79.4%), HCC (76.1%), and liver-related deaths (62.1%).
- Model outcomes were sensitive to HCV transmission rates and the annual number of individuals initiating treatment.
Conclusions:
- Current risk-based screening and treatment strategies are inadequate for achieving WHO HCV elimination targets.
- Scaling up screening and treatment may help meet mortality reduction goals but is unlikely to prevent new CHC cases.
- Enhanced harm-reduction strategies are essential for successful HCV elimination.
Background And Aims:
Despite the availability of highly effective direct-acting antiviral therapy, chronic hepatitis C (CHC) continues to cause a major public health burden. In many high-income countries, treatment rates have been declining, which was exacerbated by the impact of the COVID-19 pandemic, threatening the ability to meet the World Health Organization (WHO)'s targets for eliminating HCV as a public health threat by 2030. We sought to model the impact of CHC in Canada, a resource-rich country with ongoing immigration from HCV-endemic regions; which relies exclusively on risk-based screening for case identification.
Approach And Results:
We developed an agent-based model to characterize the HCV epidemic in a high-income country with ongoing immigration. Combinations of prevention such as harm reduction, screening, and treatment strategies were considered. Model parameters were estimated from the literature and calibrated against historical HCV data. Sensitivity analyses were performed to assess uncertainty. Under the current status quo of risk-based screening, we predict the incidence of CHC-induced decompensated cirrhosis, HCC, and liver-related deaths would decrease by 79.4%, 76.1%, and 62.1%, respectively, between 2015 and 2030, but CHC incidence would only decrease by 11.1%. The results were sensitive to HCV transmission rate and an annual number of people initiating treatment.
Conclusions:
Current risk-based screening, and subsequent treatment, will be inadequate to achieve WHO goals. With extensive scale-up in screening, and treatment, the mortality target may be achievable, but the target for preventing new CHC cases is unlikely reachable, highlighting the importance of developing enhanced harm-reduction strategies for HCV elimination.
