Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination

The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the...

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Bibliographic Details
Published in:International journal of epidemiology Vol. 47; no. 2; p. 550
Main Authors: Lim, Aaron G, Qureshi, Huma, Mahmood, Hassan, Hamid, Saeed, Davies, Charlotte F, Trickey, Adam, Glass, Nancy, Saeed, Quaid, Fraser, Hannah, Walker, Josephine G, Mukandavire, Christinah, Hickman, Matthew, Martin, Natasha K, May, Margaret T, Averhoff, Francisco, Vickerman, Peter
Format: Journal Article
Language:English
Published: England 01.04.2018
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antiviral Agents - therapeutic use
Child
Child, Preschool
Chronic Disease
Developing Countries
Epidemics - prevention & control
Female
Hepatitis C - drug therapy
Hepatitis C - mortality
Hepatitis C - prevention & control
Humans
Infant
Infant, Newborn
Male
Middle Aged
Models, Theoretical
Pakistan - epidemiology
World Health Organization
Young Adult
Pakistan
ISSN:1464-3685, 1464-3685
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Summary:The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO 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. 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. 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. 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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ISSN:1464-3685
1464-3685
DOI:10.1093/ije/dyx270