Optimal targeting of hepatitis C virus treatment among injecting drug users to those not enrolled in methadone maintenance programs

Article

Zeiler, Irmgard, Langlands, Trevor, Murray, John M. and Ritter, Alison. 2010. "Optimal targeting of hepatitis C virus treatment among injecting drug users to those not enrolled in methadone maintenance programs." Drug and Alcohol Dependence. 110 (3), pp. 228-233. https://doi.org/10.1016/j.drugalcdep.2010.03.006
Article Title

Optimal targeting of hepatitis C virus treatment among injecting drug users to those not enrolled in methadone maintenance programs

ERA Journal ID13492
Article CategoryArticle
AuthorsZeiler, Irmgard (Author), Langlands, Trevor (Author), Murray, John M. (Author) and Ritter, Alison (Author)
Journal TitleDrug and Alcohol Dependence
Journal Citation110 (3), pp. 228-233
Number of Pages6
Year2010
PublisherElsevier
Place of PublicationIreland
ISSN0376-8716
1879-0046
Digital Object Identifier (DOI)https://doi.org/10.1016/j.drugalcdep.2010.03.006
Web Address (URL)http://www.sciencedirect.com/science/article/pii/S0376871610001067
Abstract

Background: This work used mathematical modelling to explore effective policy for Hepatitis C virus (HCV) treatment in Australia in the context of methadone maintenance treatment (MMT).

Method: We consider two models to depict HCV in the population of injecting drug users (IDU) within Australia. The first model considers the IDU population as a whole. The second model includes separate components for those that are or are not enrolled in MMT. The impact of different levels of HCV treatment and its allocation dependent on MMT status were then determined in terms of the steady state levels of each of these models.

Results: Although increasing levels of HCV treatment decrease chronic infection prevalence, initially numbers
of acutely infected can rise. This is caused by the high rate of reinfection. We find that no matter the extent of HCV treatment, HCV prevalence cannot be eliminated without limiting risk behaviour. Assuming equal adherence to HCV therapy between MMT and non-MMT, over 84% of HCV treatment should be allocated to those not in MMT. Only if adherence to HCV therapy in non-MMT patients falls below 44% of that in MMT then treatment should be preferentially directed to those in MMT.

Conclusions: Contrary to generally held beliefs regarding HCV treatment the majority of therapy should be allocated to those that are still actively injecting. This is due to rates of reinfection and to the high turnover of individuals in MMT. Higher adherence to HCV therapy in MMT would need to be achieved before this changed.

Keywordshepatitis C modelling; mathematical modelling; methadone treatment
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020490409. Ordinary differential equations, difference equations and dynamical systems
490102. Biological mathematics
320211. Infectious diseases
Public Notes

File reproduced in accordance with the copyright policy of the publisher/author.

Byline AffiliationsUniversity of New South Wales
Department of Mathematics and Computing
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