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，其中包括近130万 惩教设施中的个人。注射药物使用仍然是HCV传播的最常见途径 在最近的新奥尔良，路易斯安那州的样本中，注射毒品（PWID）的人中有77％已获得HCV 过去。此外，据估计，有89％的PWID经历了监禁。 HCV与 艾滋病毒也特别常见，大约25％的艾滋病毒（PLWH）也与 HCV。此外，注射药物的PLWH约有80％也患有HCV。作为与HIV相关的发病率和 在艺术时代的PLWH中，死亡率下降了，HCV是肝癌和肝衰竭的主要原因， 已经成为发病率和死亡率的重要原因，尤其是在PWID中。 PWID和PLWH是 在被监禁的人群中表示不成比例。 这项研究建议的目的是研究HIV/HCV共感染的HCV治疗的影响 和HCV单感染了HCV消除的被监禁者。特别重要的是理解 为什么安全，治愈的治疗尚未到达大多数被监禁的HCV感染者 不知道其感染状态。 HCV治疗的高成本是该知识差距的主要原因。 高治疗价格为各州提供了巨大的激励措施 HCV。微妙甚至明显的测试和治疗障碍会持续减少净经济 影响。因此，相对于艾滋病毒，在惩教设施中几乎没有HCV测试和治疗 美国路易斯安那州通过建立替代付款策略取消了药物成本作为因素 目的是在2024年在其HCV消除计划中治疗80％的HCV感染者。在 计划，路易斯安那州为HCV药物支付相同的费用，无论接受多少人的治疗。 因此，现在我们第一次有机会严格调查HCV的负担 美国州的矫正系统，监禁动力学以及导致的感染率。 我们希望将这些新知识应用于估计治疗对社区HCV的潜在影响 传播和死亡率。在下一个周期中，我们提出研究以实现这些目标：（1）表征 HIV/HCV共同感染和HCV单感染的HIV/HCV中HCV感染的动力学 被监禁的人； （2）评估治疗影响是HCV中HCV病毒血症下降的轨迹 抗体阳性监禁者以及这种轨迹是否在患有和没有HIV的人之间有所不同； （3）解散矫正HCV治疗计划对HCV病毒降低的影响，并 评估矫正治疗计划对路易斯安那州HCV发病率和死亡率的规模扩大的影响 和其他地方。