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Modelling the Impact of Prevention and Treatment Interventions on HIV and Hepatitis C Virus Transmission Among People Who Inject Drugs in Kenya

Article scientifique 2021 Anglais

Résumé

Abstract Background People who inject drugs (PWID) in Kenya have a high prevalence of HIV (14-26%) and HCV (11-36%). Needle and syringe programmes (NSP) and antiretroviral therapy (ART) have high coverage among PWID, while HCV treatment and opioid substitution therapy (OST) access is low. Methods A dynamic model of HIV (sexual and injecting-related) and HCV (injecting-related) transmission among PWID was calibrated using Bayesian methods to data from Nairobi and the Coastal region. We projected the impact of existing coverage levels of interventions (ART: 64-66%; OST: 4-7%; NSP: 54-56%) in each setting, and the impact over 2020-2030 of increasing the coverage of OST (50%) and NSP (75%; ‘full HR’), ART (UNAIDS 90-90-90 target), HCV treatment (1000 over 5 years), and reducing HIV sexual risk by 75%. We estimated HCV treatment levels needed to reduce HCV incidence by 90% with or without full HR. Findings Since 2013, HR has averted 15.1-20.6% (range in medians across settings) of HIV infections and 29.0-31.6% of HCV infections across Nairobi and the Coastal region, with most impact being due to NSP. Conversely, ART has only averted <5% of HIV infections since 2004 because of sub-optimal viral suppression (28-48%). Going forward, Full HR and ART could reduce HIV incidence by 58.2-62.0% and HCV incidence by 62.6-81.6% by 2030 across these settings. If sexual risk is also reduced, HIV incidence would reduce by 77.1-81.4%. Alongside full HR, treating 896 PWID over 2020-2025 could reduce HCV incidence by 90% by 2030. Interpretation Existing interventions have had moderate impact on HIV and HCV transmission in Kenya, but may have substantial impact if scaled-up. However, to achieve HIV and HCV elimination, reductions in sexual risk are needed and a scale-up in HCV treatment. Funding Global Fund, MDM

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Stone, J., Fraser, H., Walker, J., Mafirakureva, N., Mundia, B., Cleland, C., Bartilol, K., Musyoki, H., Waruiru, W., Ragi, A., Bhattacharjee, P., Chhun, N., Lizcano, J., Akiyama, M., Cherutich, P., Kurth, A., Luhmann, N., Vickerman, P. (2021). Modelling the Impact of Prevention and Treatment Interventions on HIV and Hepatitis C Virus Transmission Among People Who Inject Drugs in Kenya. https://doi.org/10.1101/2021.02.02.21251008

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Auteur(s)

Jack Stone Hannah Fraser Josephine G. Walker Nyashadzaishe Mafirakureva Bernard Mundia Charles M. Cleland Kigen Bartilol Helgar Musyoki Wanjiru Waruiru Allan Ragi Parinita Bhattacharjee Nok Chhun John Lizcano Matthew J. Akiyama Peter Cherutich Ann Kurth Niklas Luhmann Peter Vickerman

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