Hepatitis C transmission and treatment as prevention: the role of the injecting network

Hellard, Margaret, McBryde, Emma, Sacks Davis, Rachel, Rolls, David A., Higgs, Peter, Aitken, Campbell, Thompson, Alex, Doyle, Joe, Pattison, Pip, and Robins, Garry (2015) Hepatitis C transmission and treatment as prevention: the role of the injecting network. International Journal of Drug Policy, 26 (10). pp. 958-962.

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DOI: 10.1016/j.drugpo.2015.05.006

View at Publisher Website: http://dx.doi.org/10.1016/j.drugpo.2015....

Abstract

Background: The hepatitis C virus (HCV) epidemic is a major health issue; in most developed countries it is driven by people who inject drugs (PWID). Injecting networks powerfully influence HCV transmission. In this paper we provide an overview of 10 years of research into injecting networks and HCV, culminating in a network-based approach to provision of direct-acting antiviral therapy.

Methods: Between 2005 and 2010 we followed a cohort of 413 PWID, measuring HCV incidence, prevalence and injecting risk, including network-related factors. We developed an individual-based HCV transmission model, using it to simulate the spread of HCV through the empirical social network of PWID. In addition, we created an empirically grounded network model of injecting relationships using exponential random graph models (ERGMs), allowing simulation of realistic networks for investigating HCV treatment and intervention strategies. Our empirical work and modelling underpins the TAP Study, which is examining the feasibility of community-based treatment of PWID with DAAs.

Results: We observed incidence rates of HCV primary infection and reinfection of 12.8 per 100 person-years (PY) (95%CI: 7.7–20.0) and 28.8 per 100 PY (95%CI: 15.0–55.4), respectively, and determined that HCV transmission clusters correlated with reported injecting relationships. Transmission modelling showed that the empirical network provided some protective effect, slowing HCV transmission compared to a fully connected, homogenous PWID population. Our ERGMs revealed that treating PWID and all their contacts was the most effective strategy and targeting treatment to infected PWID with the most contacts the least effective.

Conclusion: Networks-based approaches greatly increase understanding of HCV transmission and will inform the implementation of treatment as prevention using DAAs.


Item ID:	39732
Item Type:	Article (Research - C1)
ISSN:	1873-4758
Keywords:	hepatitis C; injecting drug use; people who inject drugs; social network; injecting network
Funders:	National Health and Medical Research Council of Australia (NHMRC), Australian Research Council (ARC), Victorian Operational Infrastructure Support Program, Burnet Institute
Projects and Grants:	NHMRC App-331312, NHMRC App-1001144, ARC DP0987730
Date Deposited:	06 Aug 2015 01:34
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 40% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 40% 16 STUDIES IN HUMAN SOCIETY > 1605 Policy and Administration > 160508 Health Policy @ 20%
SEO Codes:	92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 60% 92 HEALTH > 9203 Indigenous Health > 920309 Pacific Peoples Health - Health System Performance (incl. Effectiveness of Interventions) @ 20% 92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 20%
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