Data_Sheet_1_Treatment as prevention for hepatitis C virus in the Middle East and North Africa: a modeling study.docx

BackgroundDirect-acting antivirals opened an opportunity for eliminating hepatitis C virus (HCV) infection in the Middle East and North Africa (MENA), the region most affected by HCV infection. Impact of HCV treatment as prevention (HCV-TasP) was investigated in 19 MENA countries.
MethodsAn age-structured mathematical model was used to assess program impact using epidemiologic and programming measures. The model was fitted to a database of systematically gathered HCV antibody prevalence data. Two main scenarios were investigated for the treatment roll-out to achieve (i) 80% reduction in HCV incidence by 2030, and (ii) incidence rate < 1 per 100,000 person-years by 2030.
ResultsIn the target-80%-incidence-reduction scenario, number of treatments administrated by 2030 ranged from 2,610 in Lebanon to 180,416 in Sudan with a median of 53,079, and treatment coverage ranged between 40.2 and 78.4% with a median of 60.4%. By 2030, prevalence of chronic infection ranged between 0.0 and 0.3% with a median of 0.1%, and incidence rate, per 100,000 person-years, ranged between 0.9 and 16.3 with a median of 3.2. Program-attributed reduction in incidence rate ranged between 47.8 and 81.9% with a median of 68.5%, and number of averted infections ranged between 401 and 68,499 with a median of 8,703. Number of treatments needed to prevent one new infection ranged from 1.7 in Oman to 25.9 in Tunisia with a median of 6.5. In the target incidence rate  < 1 per 100,000 person-years scenario, number of treatments administrated by 2030 ranged from 3,470 in Lebanon to 211,912 in Sudan with a median of 54,479, and treatment coverage ranged between 55.5 and 95.9% with a median of 87.5%. By 2030, prevalence of chronic infection was less than 0.1%, and incidence rate, per 100,000 person-years, reached less than 1. Program-attributed reduction in incidence rate ranged between 61.0 and 97.5% with a median of 90.7%, and number of averted infections ranged between 559 and 104,315 with a median of 12,158. Number of treatments needed to prevent one new infection ranged from 1.3 in Oman to 25.9 in Tunisia with a median of 5.5.
ConclusionHCV-TasP is an effective and indispensable prevention intervention to control MENA’s HCV epidemic and to achieve elimination by 2030.

背景：直接抗病毒药物（Direct-acting antivirals）为中东与北非（Middle East and North Africa, MENA）地区消除丙型肝炎病毒（hepatitis C virus, HCV）感染提供了可行路径，该区域是全球HCV感染受影响最严重的地区。本研究针对19个MENA国家开展了丙型肝炎病毒治疗即预防（HCV treatment as prevention, HCV-TasP）的效果评估。

方法：本研究采用年龄结构数学模型，结合流行病学与项目实施指标评估项目干预效果。模型拟合了系统收集的HCV抗体流行率数据库。针对治疗推广设置了两类主要场景，以实现以下目标：(i) 到2030年将HCV发病率降低80%；(ii) 到2030年将发病率降至每10万人年<1例。

结果：在“将发病率降低80%”的目标场景中，截至2030年的累计治疗给药数量范围为黎巴嫩的2610例至苏丹的180416例，中位数为53079例；治疗覆盖率介于40.2%至78.4%之间，中位数为60.4%。至2030年，慢性HCV感染流行率介于0.0%至0.3%之间，中位数为0.1%；每10万人年的发病率介于0.9至16.3之间，中位数为3.2。项目相关的发病率下降幅度介于47.8%至81.9%之间，中位数为68.5%；避免的感染病例数介于401例至68499例之间，中位数为8703例。每避免1例新增感染所需的治疗次数范围为阿曼的1.7次至突尼斯的25.9次，中位数为6.5次。
在“发病率<1/10万人年”的目标场景中，截至2030年的累计治疗给药数量范围为黎巴嫩的3470例至苏丹的211912例，中位数为54479例；治疗覆盖率介于55.5%至95.9%之间，中位数为87.5%。至2030年，慢性HCV感染流行率低于0.1%，每10万人年的发病率降至1以下。项目相关的发病率下降幅度介于61.0%至97.5%之间，中位数为90.7%；避免的感染病例数介于559例至104315例之间，中位数为12158例。每避免1例新增感染所需的治疗次数范围为阿曼的1.3次至突尼斯的25.9次，中位数为5.5次。

结论：丙型肝炎病毒治疗即预防（HCV-TasP）是控制MENA地区HCV流行、并在2030年前实现消除目标的有效且不可或缺的预防干预手段。