Table 1 Scenarios considered. Each setting was run with all combinations of the listed interventions and their variants
From: The case for a universal hepatitis C vaccine to achieve hepatitis C elimination
Intervention | Variants of intervention | Model implementation and assumptions |
|---|---|---|
Testing/treatment among PWID | No testing or two yearly, annual, and six monthly testing | Testing coverage was modelled to be 80%, with 70% and 90% coverage used to derive uncertainty bounds. The programme assumed that following a positive antibody test, 80% of PWID were retained in care to have an RNA/cAg test within 3 months, and once diagnosed RNA/cAg + PWID would commence DAA treatment after an average of 60 days (with 95% success). Retention in care, time between follow-up tests and time to commence treatment were tested in the sensitivity analysis. |
Testing/treatment among the general community | No testing or testing to result in the entire infected population being screened over a 12-year period (2018–2030) | This was implemented as 1/12th of people with hepatitis C in the general population being diagnosed every year between 2018 and 2030. Similar follow-up and treatment commencement assumptions to the testing interventions among PWID. Testing was only for people covered by the health system (80% of the population, with 70% and 90% used to derive uncertainty bounds). |
Vaccination of PWID | No vaccination or a 75% efficacious vaccine with a 10-year duration of protection. | It was assumed that the vaccine was delivered with a test and treat strategy (frequency of testing being scenario dependent). Susceptible PWID were vaccinated after testing and infected PWID were treated and then vaccinated after SVR. The vaccine efficacy and duration of protection were tested in the sensitivity analysis. In particular, a scenario where the vaccine is only half as efficacious for people after successful treatment. |
Combined testing and vaccination of the general community | No vaccination or a 75% efficacious vaccine with a 10-year duration of protection. | It was assumed that the vaccine was delivered with the general community testing programme. Susceptible people were vaccinated after testing and infected people were treated and then vaccinated. The vaccine efficacy and duration of protection were tested in the sensitivity analysis. |
Age-based vaccination of the general community | No vaccination or a 75% efficacious vaccine with a 10-year duration of protection. | People were assumed to receive a vaccination as they entered the model (i.e. turned 15 years old), as this is a common age for delivering adolescent vaccination programmes. The vaccine efficacy and duration of protection were tested in the sensitivity analysis. |