The Impact of HCV Treatment in HIV/HCV coinfected and HCV monoinfected Incarcerated Persons on HCV Elimination

HIV/HCV 共同感染者和 HCV 单一感染者的 HCV 治疗对消除 HCV 的影响

• 批准号: 10159648
• 负责人: Risha Irvin
• 金额: $ 82.63万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10159648
• 关键词: Age; Antiviral Agents; Chronic Hepatitis C; Clinic; Communities; Continuity of Patient Care; Data; Databases; Drug usage; Ensure; Epidemic; Epidemiology; Funding; Future; Goals; HIV; HIV Infections; HIV Seropositivity; HIV/HCV; Harm Reduction; Health; Hepatitis C; Hepatitis C Acquisition; Hepatitis C Antibodies; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C Viremia; Hepatitis C co-infection; Hepatitis C virus; Imprisonment; Incentives; Incidence; Individual; Infection; Injecting drug user; Intervention; Jail; Knowledge; Learning; Liver Failure; Louisiana; Malignant neoplasm of liver; Modeling; Morbidity - disease rate; Persons; Pharmaceutical Preparations; Population; Prevalence; Price; Prisons; Public Health; RNA; Race; Research; Research Proposals; Risk Behaviors; Route; Sampling; Testing; Time; base; chronic infection; correctional system; cost; curative treatments; design; economic impact; experience; flexibility; improved; infection burden; injection drug use; models and simulation; mortality; payment; peer support; programs; scale up; sex; success; tool; transmission process; treatment program; viral RNA

Summary/Abstract In the U.S., 2.7 million individuals are estimated to have chronic HCV infection which includes nearly 1.3 million individuals in correctional facilities. Injection drug use remains the most common route of HCV transmission and in a recent New Orleans, Louisiana sample, 77% of people who inject drugs (PWID) had acquired HCV in the past. Moreover, it is estimated that 89% of PWID have experienced incarceration. HCV coinfection with HIV is also particularly common with approximately 25% of people living with HIV (PLWH) also coinfected with HCV. Furthermore, about 80% of PLWH who inject drugs also have HCV. As HIV-related morbidity and mortality have declined among PLWH in the ART era, HCV, a leading cause of liver cancer and liver failure, has emerged as an important cause of morbidity and mortality especially among PWID. PWID and PLWH are disproportionately represented in incarcerated populations. The purpose of this research proposal is to investigate the impact of HCV treatment of HIV/HCV coinfected and HCV monoinfected incarcerated persons on HCV elimination. Of particular importance is understanding why safe, curative treatment has not reached most of the incarcerated HCV infected persons who largely are unaware of their infected status. The high cost of HCV treatment is a major reason for this knowledge gap. High treatment prices provide an enormous incentive for states to shroud the epidemiology and treatment of HCV. Subtle and even overt barriers to testing and treatment are sustained to diminish the net economic impact. Accordingly, relative to HIV, little HCV testing and treatment has occurred in correctional facilities in the U.S. Louisiana removed the cost of medications as a factor by establishing an alternative payment strategy with the goal of treating 80% of HCV infected persons by 2024 in their HCV Elimination Program. Under the program, Louisiana pays the same amount for HCV medications no matter how many persons are treated. Thus, now for the first time, we have the opportunity to investigate rigorously the burden of HCV in the correctional system in a U.S. state, the dynamics of incarceration, and the resulting prevalence of infection. We want to apply this new knowledge to estimating the potential impact of treatment on community HCV transmission and mortality. In the next cycle, we propose research to achieve these aims: (1) To characterize the dynamics of HCV infection in the correctional system among HIV/HCV coinfected and HCV monoinfected incarcerated persons; (2) To assess treatment impact as the trajectory of decline in HCV viremia among HCV antibody positive incarcerated persons and whether this trajectory differs between those with and without HIV; (3) To disentangle the impact of the correctional HCV treatment program on HCV viremic decline, and to assess the impact of scale-up of correctional treatment programs on HCV incidence and mortality in Louisiana and elsewhere.

摘要/摘要 在美国，估计有 270 万人患有慢性 HCV 感染，其中近 130 万人 惩教设施中的个人。注射吸毒仍然是丙型肝炎病毒最常见的传播途径 在路易斯安那州新奥尔良最近的一项样本中，77% 的注射吸毒者 (PWID) 在 过去。此外，据估计 89% 的吸毒者曾被监禁。 HCV 合并感染 HIV 也特别常见，大约 25% 的 HIV 感染者 (PLWH) 还同时感染 丙肝病毒。此外，约 80% 的注射吸毒感染者也患有丙肝病毒。由于艾滋病毒相关的发病率和 在 ART 时代，艾滋病病毒感染者的死亡率有所下降，丙型肝炎病毒是导致肝癌和肝功能衰竭的主要原因， 已成为发病率和死亡率的一个重要原因，特别是在吸毒者中。 PWID 和 PLWH 是 在被监禁人口中所占比例过高。 本研究计划的目的是调查 HCV 治疗对 HIV/HCV 合并感染者的影响 和 HCV 单一感染者的 HCV 消除。尤其重要的是理解 为什么大多数被监禁的 HCV 感染者尚未获得安全、治愈的治疗 不知道自己的感染状况。 HCV 治疗的高昂费用是造成这种知识差距的主要原因。 高治疗价格为各国掩盖流行病学和治疗提供了巨大的动力 丙肝病毒。对检测和治疗的微妙甚至公开的障碍持续存在，从而减少了净经济 影响。因此，相对于艾滋病毒，该国惩教机构中几乎没有进行丙型肝炎病毒检测和治疗。 美国路易斯安那州通过建立替代支付策略消除了药物成本这一因素 其目标是到 2024 年在 HCV 消除计划中治疗 80% 的 HCV 感染者。下 根据该计划，无论有多少人接受治疗，路易斯安那州都会为丙肝病毒药物支付相同的金额。 因此，现在我们第一次有机会严格调查丙型肝炎病毒的负担 美国各州的惩教系统、监禁的动态以及由此产生的感染流行率。 我们希望应用这一新知识来估计治疗对社区丙型肝炎的潜在影响 传播和死亡率。在下一个周期中，我们建议进行研究以实现这些目标：（1）表征 惩教系统中 HIV/HCV 合并感染者和 HCV 单一感染者的 HCV 感染动态 被监禁者； (2) 将治疗影响评估为 HCV 中 HCV 病毒血症下降的轨迹 抗体呈阳性的被监禁者以及感染艾滋病毒和未感染艾滋病毒的人之间的这一轨迹是否不同； (3) 阐明丙型肝炎纠正治疗方案对丙型肝炎病毒血症下降的影响，并 评估扩大矫正治疗计划对路易斯安那州 HCV 发病率和死亡率的影响 和其他地方。