TY - JOUR
T1 - Modelling the impact of HIV and hepatitis C virus prevention and treatment interventions among people who inject drugs in Kenya
AU - Stone, Jack
AU - Fraser, Hannah
AU - Walker, Josephine G.
AU - Mafirakureva, Nyashadzaishe
AU - Mundia, Bernard
AU - Cleland, Charles
AU - Bartilol, Kigen
AU - Musyoki, Helgar
AU - Waruiru, Wanjiru
AU - Ragi, Allan
AU - Bhattacharjee, Parinita
AU - Chhun, Nok
AU - Lizcano, John
AU - Akiyama, Matthew J.
AU - Cherutich, Peter
AU - Wisse, Ernst
AU - Kurth, Ann
AU - Luhmann, Niklas
AU - Vickerman, Peter
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Objectives:People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and hepatitis C virus (HCV; 11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya.Design:HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region.Methods:For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction [Full harm reduction ('Full HR'): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030.Results:In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly because of NSP. ART only averted 12.9-39.8% of HIV infections because of suboptimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside full HR, treating 2244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030.Conclusion:Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
AB - Objectives:People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and hepatitis C virus (HCV; 11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya.Design:HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region.Methods:For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction [Full harm reduction ('Full HR'): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030.Results:In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly because of NSP. ART only averted 12.9-39.8% of HIV infections because of suboptimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside full HR, treating 2244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030.Conclusion:Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
KW - HIV
KW - Kenya
KW - hepatitis C virus
KW - mathematical modelling
KW - people who inject drugs
UR - http://www.scopus.com/inward/record.url?scp=85142400603&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85142400603&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000003382
DO - 10.1097/QAD.0000000000003382
M3 - Article
C2 - 36111533
AN - SCOPUS:85142400603
SN - 0269-9370
VL - 36
SP - 2191
EP - 2201
JO - AIDS
JF - AIDS
IS - 15
ER -