Treatment as prevention for hepatitis C virus in Pakistan: Mathematical modelling projections

Abstract

Objective Direct-Acting antivirals have opened an opportunity for controlling hepatitis C virus (HCV) infection in Pakistan, where 10% of the global infection burden is found. We aimed to evaluate the implications of five treatment programme scenarios for HCV treatment as prevention (HCV-TasP) in Pakistan. Design An age-structured mathematical model was used to evaluate programme impact using epidemiological and programme indicators. Setting Total Pakistan population. Participants Total Pakistan HCV-infected population. Interventions HCV treatment programme scenarios from 2018 up to 2030. Results By 2030 across the five HCV-TasP scenarios, 0.6-7.3 million treatments were administered, treatment coverage reached between 3.7% and 98.7%, prevalence of chronic infection reached 2.4%-0.03%, incidence reduction ranged between 41% and 99%, program-Attributed reduction in incidence rate ranged between 7.2% and 98.5% and number of averted infections ranged between 126 221 and 750 547. Annual incidence rate reduction in the first decade of the programme was around 6%-18%. Number of treatments needed to prevent one new infection ranged between 4.7-9.8, at a drug cost of about US900. Cost of the programme by 2030, in the most ambitious elimination scenario, reached US708 million. Stipulated WHO target for 2030 cannot be accomplished without scaling up treatment to 490 000 per year, and maintaining it for a decade. Conclusion HCV-TasP is a highly impactful and potent approach to control Pakistan's HCV epidemic and achieve elimination by 2030