Purpose Intravenous opioid use is a major contributor to the increases in hepatitis C virus (HCV) incidence observed among young adults during the past decade. HCV is a bloodborne virus; because transmission occurs through sharing syringes or other injection equipment, persons who inject drugs (PWID) are the primary group at risk for new HCV infection. Long-term HCV infection can cause cirrhosis or hepatocellular carcinoma. HCV is curable, but treatment is expensive and often unavailable to PWID. We used an HCV transmission model to predict the potential impact of primary (reducing injection initiation), secondary (reducing injection drug use relapse or effective contacts and increasing cessation), and tertiary (HCV treatment) interventions on incident and prevalent HCV cases in Michigan.
Methods We fit an ordinary differential equation HCV transmission model with preferential age mixing to newly reported chronic HCV cases aged 15–30 years reported to the Michigan Department of Health and Human Services. After adjusting for under-reporting and incorporating parameter uncertainty using Latin hypercube sampling, we simulated the potential impact of several interventions.
Results Reducing injection initiation and HCV treatment interventions among former PWID predicted reductions in HCV prevalence; however, only injection initiation interventions predicted incidence reductions. For example, reducing initiation by 10% or treating 10% of former PWID per year predicted a 20% reduction in prevalence, on average. Treatment had no predicted impact on incidence while reducing injection initiation predicted a reduction of 15%.
Conclusion Results supported that while several strategies could reduce prevalence, decreasing injection initiation is more likely to reduce HCV incidence than HCV treatment.
Significance PWID are at high risk of acquiring HCV, and if untreated, of developing liver-related injury and transmitting HCV to others. Incorporating HCV surveillance data into simulation models provides a new opportunity to evaluate HCV intervention strategies among young PWID.
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