Modeling hepatitis C micro-elimination among people who inject drugs with direct-acting antivirals in metropolitan Chicago

Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease and mortality worldwide. Direct-acting antiviral (DAA) therapy leads to high cure rates. However, persons who inject drugs (PWID) are at risk for reinfection after cure and may require multiple DAA treatments to reach the World Health Organization’s (WHO) goal of HCV elimination by 2030. Using an agent-based model (ABM) that accounts for the complex interplay of demographic factors, risk behaviors, social networks, and geographic location for HCV transmission among PWID, we examined the combination(s) of DAA enrollment (2.5%, 5%, 7.5%, 10%), adherence (60%, 70%, 80%, 90%) and frequency of DAA treatment courses needed to achieve the WHO’s goal of reducing incident chronic infections by 90% by 2030 among a large population of PWID from Chicago, IL and surrounding suburbs. We also estimated the economic DAA costs associated with each scenario. Our results indicate that a DAA treatment rate of >7.5% per year with 90% adherence results in 75% of enrolled PWID requiring only a single DAA course; however 19% would require 2 courses, 5%, 3 courses and <2%, 4 courses, with an overall DAA cost of $325 million to achieve the WHO goal in metropolitan Chicago. We estimate a 28% increase in the overall DAA cost under low adherence (70%) compared to high adherence (90%). Our modeling results have important public health implications for HCV elimination among U.S. PWID. Using a range of feasible treatment enrollment and adherence rates, we report robust findings supporting the need to address re-exposure and reinfection among PWID to reduce HCV incidence

Hepatitis C infection among young injection drug users: Prevalence, chronicity and viral load fluctuation.

Hepatitis C infection among young injection drug users: Prevalence, chronicity and viral load fluctuation

Computational discovery of effective hepatitis C intervention strategies

This project aims to develop a comprehensive, data-driven agent-based model for Hepatitis C Elimination in people who inject drugs (PWID) (HepCEP) using the Chicago PWID population as a template and proof of concept that would enable policy makers to identify the most effective intervention strategies for elimination of hepatitis C by 2030 based on the WHO proposed reduction estimates

Journal of AIDS and HIV Research Collecting whole network data for human immunodeficiency virus prevention: A review of current strategies

The study of social networks is essential to understanding the spread of infectious diseases. This study reviews strategies for collecting whole (that is, sociometric) network data for human immunodeficiency virus (HIV) prevention. Using selected criteria, peer-reviewed journal articles published from 1980 to 2012 were searched in ISI Web of Knowledge and PsychInfo databases, and social network journals. Data from articles represent 12 whole network studies; the preponderance of the remaining articles was from personal (that is, egocentric) network studies. A common approach used to devise a whole network was recruiting and linking personal networks. Other approaches included venue-based linkages and use of a population roster. Ethnography and chain referral methods were key components of a multi-method approach to successfully acquiring a whole network. Few studies adequately explicate data collection and linking methodologies. Potential ways to augment and standardize reporting for similar studies are suggested

Contextual Risk Factors for Hepatitis C among Young Persons Who Inject Drugs

Longitudinal study of young persons who inject drugs and hepatitis C ris

Feasibility of ecological momentary assessment to study mood and risk behavior among young people who inject drugs

AIMS: To test the acceptability and feasibility of ecological momentary assessment (EMA) of mood and injection risk behavior among young people who inject drugs (PWID), using mobile phones. METHODS: Participants were 185 PWID age 18-35 recruited from two sites of a large syringe service program in Chicago. After completing a baseline interview, participants used a mobile phone app to respond to momentary surveys on mood, substance use, and injection risk behavior for 15 days. Participants were assigned to receive surveys 4, 5, or 6 times per day. RESULTS: Participants were 68% male, 61% non-Hispanic white, 24% Hispanic, and 5% non-Hispanic Black. Out of 185 participants, 8% (n = 15) failed to complete any EMA assessments. Among 170 EMA responders, the mean number of days reporting was 10 (SD 4.7), the mean proportion of assessments completed was 0.43 (SD 0.27), and 76% (n = 130) completed the follow-up interview. In analyses adjusted for age and race/ethnicity, women were more responsive than men to the EMA surveys in days reporting (IRR = 1.33, 95% CI 1.13-1.56), and total number of surveys completed (IRR = 1.51, 95% CI 1.18-1.93). Homeless participants responded on fewer days (IRR = 0.76, 95% CI 0.64-0.90) and completed fewer surveys (IRR = 0.70, 95% CI 0.54-0.91), and were less likely to return for follow-up (p = 0.016). EMA responsiveness was not significantly affected by the number of assigned daily assessments. CONCLUSIONS: This study demonstrated high acceptability and feasibility of EMA among young PWID, with up to 6 survey prompts per day. However, homelessness significantly hampered successful participation

Another published paper

Trends in homelessness and injection practice

Lessons learned from a hepatitis C testing, case management and linkage to care program for persons who inject drugs from metropolitan Chicago

The Chicago Hepatitis C (HCV) Testing, Case Management and Linkage to Care Program (HepCLink) provided HCV testing, case management and linkage to medical care for persons who inject drugs (PWID) in metropolitan Chicago, Illinois, U.S.A. In year 1, we screened 1,005 PWID for HCV antibodies (67% male; 43% non-Hispanic (NH) black, 31% NH-white, 22% Hispanic, 4% other; 52% uninsured). Of the 20% (n=204) who were HCV antibody-positive, 77 (38%) followed-through with HCV viral load testing; 84% (n=65) of whom were chronically infected. A novel HCV-focused case management program was developed in year 1 to address treatment initiation barriers among PWID. Most participants reported multiple barriers (e.g. unstable housing, uninsured) that required an extensive period (i.e. >1 year) to address prior to treatment readiness. Lessons learned during year 1 of HepCLink have informed strategic revisions in years 2-3 that have improved testing uptake, follow-up and treatment readiness outcomes