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. 2021 Aug 21;27(31):5219-5231.
doi: 10.3748/wjg.v27.i31.5219.

Planning the hepatitis C virus elimination in Cyprus: A modeling study

Ilias Gountas  1 , Ioanna Yiasemi  2 , Evi Kyprianou  2 , Christos Mina  2 , Chrysanthos Georgiou  3 , Petros Katsioloudes  4 , Andri Kouroufexi  5 , Anna Demetriou  6 , Elena Xenofontos  7 , Georgios Nikolopoulos  8
Affiliations

Planning the hepatitis C virus elimination in Cyprus: A modeling study

Ilias Gountas et al. World J Gastroenterol. .

Abstract

Background: Hepatitis C virus (HCV) infection is a major global public health problem. In the Republic of Cyprus, the estimated prevalence of chronic hepatitis C (CHC) among the general population is 0.6%, while the CHC prevalence among people who inject drugs (PWID) is estimated at 46%. Direct-acting antivirals that can eliminate HCV are not yet widely available in the Republic of Cyprus. However, when direct-acting antivirals become available, a long-term strategic plan to guide elimination efforts will be needed to maximize the effect of treatment.

Aim: To determine the programmatic targets to eliminate HCV in the Republic of Cyprus.

Methods: A dynamic, stochastic, individual-based model of HCV transmission, disease progression, and cascade of care was calibrated to data from Cyprus. The model stratifies the population into the infected general population and the PWID population. A variety of test, prevention, and treatment strategies concerning the general population, PWID, or both were examined. The time horizon of the analysis was until 2034.

Results: Under the status quo scenario, the model predicted that 75 (95% confidence interval (CI): 60, 91) and 575 (95%CI: 535, 615) liver-related deaths and new infections would occur by 2034, respectively. Launching an expanded treatment program, without screening interventions, would cause modest outcomes regarding CHC prevalence (16.6% reduction in 2034 compared to 2020) and liver-related deaths (10 deaths would be prevented compared to the status quo scenario by 2034). Implementing a test and treat strategy among the general population but without any intervention in the PWID population would suffice to meet the mortality target but not the incidence target. To achieve HCV elimination in Cyprus, 3080 (95%CI: 3000, 3200) HCV patients need to be diagnosed and treated by 2034 (2680 from the general population and 400 from PWID), and harm reduction coverage among PWID should be increased by 3% per year (from 25% in 2020 to 67% in 2034).

Conclusion: Elimination of HCV is a demanding public health strategy, which requires significant interventions both among the general population and high-risk groups.

Keywords: Direct-acting antivirals; Hepatitis C virus elimination; Mathematical modelling; Projections; Screening campaigns.

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Conflict of interest statement

Conflict-of-interest statement: Ilias Gountas reports grants from GILEAD and AbbVie, outside the submitted work; Georgios Nikolopoulos reports grants from ASKLEPIOS GILEAD GRANT, outside the submitted work; all the other authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Model projections of future prevalence of chronic hepatitis C virus in the Republic of Cyprus under different scenarios for the total infected population, the general population (i.e. total infected population minus infected people who inject drugs), and the infected people who inject drugs. Α: Total population; Β: General population (GP); C: People who inject drugs (PWID). CI: Confidence interval.
Figure 2
Figure 2
Model predictions for cumulative hepatitis C virus related deaths in the Republic of Cyprus under different scenarios.
Figure 3
Figure 3
Model predictions for hepatitis C virus new cases (incidence) among people who inject drugs in the Republic of Cyprus under different scenarios. HCV: Hepatitis C virus.
Figure 4
Figure 4
Model estimations concerning the cumulative and annual number of antiviral treatments of each scenario. A: Cumulative treatments; B: Annual treatments.
See this image and copyright information in PMC

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