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
ARTICLE HIGHLIGHTS
Research background

Hepatitis C virus (HCV) infection is a major global public health problem. Although direct-acting antivirals are capable to eliminate HCV, they are not yet widely available in Cyprus. However, when direct-acting antivirals become available, an appropriate long-term strategic plan to guide elimination efforts will be necessary to maximize the benefits of treatment.

Research motivation

An appropriate long-term elimination plan will maximize the benefits of treatment.

Research objectives

This study aims to simulate the implementation of an integrated HCV strategy in the Republic of Cyprus to determine the programmatic targets to eliminate HCV.

Research methods

A dynamic, discrete-time, stochastic, individual-based model of HCV transmission, disease progression, and a cascade of care was fitted to epidemiological and clinical data from the Republic of Cyprus. The model stratifies the population into two groups: the infected general population [e.g., HCV+ but not people who inject drugs (PWID)] and the PWID population. The model was run until it achieved a steady-state (the level of prevalence in PWID population in 2020 without the use of a treatment) by varying the infection rate. After reaching a steady-state, the model was seeded with a cohort that represents the infected patients from the general population (size of the infected population, fibrosis stage, share of diagnosed, and mean age of the infected patients).

Research results

The analysis showed that under the status quo scenario 75 (95% confidence interval: 60, 91) and 575 (95% confidence interval: 535, 615) liver-related deaths and new infections would occur by 2034, respectively. Without screening interventions, launching an expanded treatment program would cause modest outcomes regarding chronic hepatitis C 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% confidence interval: 3000, 3200) 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).

Research conclusions

Our study highlighted that without the implementation of large awareness or screening programs, HCV elimination cannot be achieved, due to suboptimal treatment coverage. Elimination of HCV is a demanding public health strategy that requires significant public health reforms (e.g., enhancing harm reduction programs, implementing case-finding, linkage to care interventions).

Research perspectives

Elimination of HCV is a demanding public health intervention, which poses significant challenges in any health care system. Nevertheless, our analysis highlighted that HCV elimination is an achievable target.