The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals?
<h4>Background and aims</h4>The advent of highly effective hepatitis C (HCV) treatments has questioned the need for a vaccine to control HCV amongst people who inject drugs (PWID). However, high treatment costs and ongoing reinfection risk suggest it could still play a role. We compared...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2016-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0156213&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850133318496944128 |
|---|---|
| author | Jack Stone Natasha K Martin Matthew Hickman Margaret Hellard Nick Scott Emma McBryde Heidi Drummer Peter Vickerman |
| author_facet | Jack Stone Natasha K Martin Matthew Hickman Margaret Hellard Nick Scott Emma McBryde Heidi Drummer Peter Vickerman |
| author_sort | Jack Stone |
| collection | DOAJ |
| description | <h4>Background and aims</h4>The advent of highly effective hepatitis C (HCV) treatments has questioned the need for a vaccine to control HCV amongst people who inject drugs (PWID). However, high treatment costs and ongoing reinfection risk suggest it could still play a role. We compared the impact of HCV vaccination amongst PWID against providing HCV treatment.<h4>Methods</h4>Dynamic HCV vaccination and treatment models among PWID were used to determine the vaccination and treatment rates required to reduce chronic HCV prevalence or incidence in the UK over 20 or 40 years. Projections considered a low (50% protection for 5 years), moderate (70% protection for 10 years) or high (90% protection for 20 years) efficacy vaccine. Sensitivities to various parameters were examined.<h4>Results</h4>To halve chronic HCV prevalence over 40 years, the low, moderate and high efficacy vaccines required annual vaccination rates (coverage after 20 years) of 162 (72%), 77 (56%) and 44 (38%) per 1000 PWID, respectively. These vaccination rates were 16, 7.6 and 4.4 times greater than corresponding treatment rates. To halve prevalence over 20 years nearly doubled these vaccination rates (moderate and high efficacy vaccines only) and the vaccination-to-treatment ratio increased by 20%. For all scenarios considered, required annual vaccination rates and vaccination-to-treatment ratios were at least a third lower to reduce incidence than prevalence. Baseline HCV prevalence had little effect on the vaccine's impact on prevalence or incidence, but substantially affected the vaccination-to-treatment ratios. Behavioural risk heterogeneity only had an effect if we assumed no transitions between high and low risk states and vaccinations were targeted or if PWID were high risk for their first year.<h4>Conclusions</h4>Achievable coverage levels of a low efficacy prophylactic HCV vaccine could greatly reduce HCV transmission amongst PWID. Current high treatment costs ensure vaccination could still be an important intervention option. |
| format | Article |
| id | doaj-art-20eb43fce7434fd5a6df5004babe6c13 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-20eb43fce7434fd5a6df5004babe6c132025-08-20T02:31:59ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01115e015621310.1371/journal.pone.0156213The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals?Jack StoneNatasha K MartinMatthew HickmanMargaret HellardNick ScottEmma McBrydeHeidi DrummerPeter Vickerman<h4>Background and aims</h4>The advent of highly effective hepatitis C (HCV) treatments has questioned the need for a vaccine to control HCV amongst people who inject drugs (PWID). However, high treatment costs and ongoing reinfection risk suggest it could still play a role. We compared the impact of HCV vaccination amongst PWID against providing HCV treatment.<h4>Methods</h4>Dynamic HCV vaccination and treatment models among PWID were used to determine the vaccination and treatment rates required to reduce chronic HCV prevalence or incidence in the UK over 20 or 40 years. Projections considered a low (50% protection for 5 years), moderate (70% protection for 10 years) or high (90% protection for 20 years) efficacy vaccine. Sensitivities to various parameters were examined.<h4>Results</h4>To halve chronic HCV prevalence over 40 years, the low, moderate and high efficacy vaccines required annual vaccination rates (coverage after 20 years) of 162 (72%), 77 (56%) and 44 (38%) per 1000 PWID, respectively. These vaccination rates were 16, 7.6 and 4.4 times greater than corresponding treatment rates. To halve prevalence over 20 years nearly doubled these vaccination rates (moderate and high efficacy vaccines only) and the vaccination-to-treatment ratio increased by 20%. For all scenarios considered, required annual vaccination rates and vaccination-to-treatment ratios were at least a third lower to reduce incidence than prevalence. Baseline HCV prevalence had little effect on the vaccine's impact on prevalence or incidence, but substantially affected the vaccination-to-treatment ratios. Behavioural risk heterogeneity only had an effect if we assumed no transitions between high and low risk states and vaccinations were targeted or if PWID were high risk for their first year.<h4>Conclusions</h4>Achievable coverage levels of a low efficacy prophylactic HCV vaccine could greatly reduce HCV transmission amongst PWID. Current high treatment costs ensure vaccination could still be an important intervention option.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0156213&type=printable |
| spellingShingle | Jack Stone Natasha K Martin Matthew Hickman Margaret Hellard Nick Scott Emma McBryde Heidi Drummer Peter Vickerman The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? PLoS ONE |
| title | The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? |
| title_full | The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? |
| title_fullStr | The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? |
| title_full_unstemmed | The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? |
| title_short | The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? |
| title_sort | potential impact of a hepatitis c vaccine for people who inject drugs is a vaccine needed in the age of direct acting antivirals |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0156213&type=printable |
| work_keys_str_mv | AT jackstone thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT natashakmartin thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT matthewhickman thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT margarethellard thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT nickscott thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT emmamcbryde thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT heididrummer thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT petervickerman thepotentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT jackstone potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT natashakmartin potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT matthewhickman potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT margarethellard potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT nickscott potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT emmamcbryde potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT heididrummer potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals AT petervickerman potentialimpactofahepatitiscvaccineforpeoplewhoinjectdrugsisavaccineneededintheageofdirectactingantivirals |