Basic Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2021; 27(31): 5219-5231
Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5219
Planning the hepatitis C virus elimination in Cyprus: A modeling study
Ilias Gountas, Ioanna Yiasemi, Evi Kyprianou, Christos Mina, Chrysanthos Georgiou, Petros Katsioloudes, Andri Kouroufexi, Anna Demetriou, Elena Xenofontos, Georgios Nikolopoulos
Ilias Gountas, Georgios Nikolopoulos, Medical School, University of Cyprus, Nicosia 1678, Cyprus
Ioanna Yiasemi, Evi Kyprianou, Christos Mina, Cyprus Monitoring Centre, Cyprus National Addictions Authority, Nicosia 1678, Cyprus
Chrysanthos Georgiou, Nicosia General Hospital, Nicosia 1678, Cyprus
Petros Katsioloudes, Evangelistria Medical Centre, Nicosia 1678, Cyprus
Andri Kouroufexi, Ministry of Health, Pharmaceutical Services, Nicosia 1678, Cyprus
Anna Demetriou, Ministry of Health, Health Monitoring Unit, Nicosia 1678, Cyprus
Elena Xenofontos, Department of Internal Medicine, Limassol General Hospital, Limassol 4131, Cyprus
Author contributions: Gountas I and Nikolopoulos G conceived the study; Gountas I performed the modelling and drafted the manuscript; Nikolopoulos G coordinated the study; Yiasemi I, Kyprianou E, Mina C, Georgiou C, Katsioloudes P, Kouroufexi A, Demetriou A, Xenofontos E, and Nikolopoulos G provided essential input and contributed extensively to writing the manuscript; all authors contributed to model interpretation and approved the final version.
Supported by the Onisilos Funding Scheme of the University of Cyprus.
Conflict-of-interest statement: Ilias Gountas reports grants from GILEAD and AbbVie, outside the submitted work; Georgios Nikolopoulos reports grants from ASKLEPIOS GILEAD GRANT, outside the submitted work; all the other authors have no conflicts of interest.
Data sharing statement: All relevant data are within the paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ilias Gountas, PhD, Postdoc, Senior Statistician, Statistician, Teacher, Medical School, University of Cyprus, Kalipoleos 75, Nicosia 1678, Cyprus. hgkoyntas@med.uoa.gr
Received: February 10, 2021
Peer-review started: February 10, 2021
First decision: May 1, 2021
Revised: May 13, 2021
Accepted: July 16, 2021
Article in press: July 16, 2021
Published online: August 21, 2021
Processing time: 188 Days and 15.3 Hours
Abstract
BACKGROUND

Hepatitis C virus (HCV) infection is a major global public health problem. In the Republic of Cyprus, the estimated prevalence of chronic hepatitis C (CHC) among the general population is 0.6%, while the CHC prevalence among people who inject drugs (PWID) is estimated at 46%. Direct-acting antivirals that can eliminate HCV are not yet widely available in the Republic of Cyprus. However, when direct-acting antivirals become available, a long-term strategic plan to guide elimination efforts will be needed to maximize the effect of treatment.

AIM

To determine the programmatic targets to eliminate HCV in the Republic of Cyprus.

METHODS

A dynamic, stochastic, individual-based model of HCV transmission, disease progression, and cascade of care was calibrated to data from Cyprus. The model stratifies the population into the infected general population and the PWID population. A variety of test, prevention, and treatment strategies concerning the general population, PWID, or both were examined. The time horizon of the analysis was until 2034.

RESULTS

Under the status quo scenario, the model predicted that 75 (95% confidence interval (CI): 60, 91) and 575 (95%CI: 535, 615) liver-related deaths and new infections would occur by 2034, respectively. Launching an expanded treatment program, without screening interventions, would cause modest outcomes regarding CHC prevalence (16.6% reduction in 2034 compared to 2020) and liver-related deaths (10 deaths would be prevented compared to the status quo scenario by 2034). Implementing a test and treat strategy among the general population but without any intervention in the PWID population would suffice to meet the mortality target but not the incidence target. To achieve HCV elimination in Cyprus, 3080 (95%CI: 3000, 3200) HCV patients need to be diagnosed and treated by 2034 (2680 from the general population and 400 from PWID), and harm reduction coverage among PWID should be increased by 3% per year (from 25% in 2020 to 67% in 2034).

CONCLUSION

Elimination of HCV is a demanding public health strategy, which requires significant interventions both among the general population and high-risk groups.

Keywords: Mathematical modelling; Projections; Hepatitis C virus elimination; Direct-acting antivirals; Screening campaigns

Core Tip: Direct-acting antivirals (DAAs) that can eliminate hepatitis C virus are not yet available in the Republic of Cyprus. However, when DAAs become available, a long-term strategic plan to guide elimination efforts will be needed to maximize the effect of treatment. To achieve the elimination goals, 3080 patients need to be diagnosed and treated by 2034 (2680 from the general population and 400 from people who inject drugs), and harm reduction coverage among people who inject drugs should be increased by 3% per year.