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Title: Modelling the elimination of hepatitis C virus infection as a public health threat
Author: Heffernan, Alastair
ISNI:       0000 0004 7969 8850
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2019
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The revolution in hepatitis C virus treatment through the development of direct-acting antivirals has generated international interest in the elimination of the disease as a public health threat. This led the World Health Organization to establish viral hepatitis elimination targets. Whether these targets can be met and how intervention programmes should be scaled up in specific settings are open questions. This thesis details how mathematical models were developed and used to answer these questions. A model of the hepatitis C epidemic was designed and the impact of a range of intervention strategies estimated. A comprehensive package of prevention, screening and treatment interventions could avert 15 million new infections and 1.5 million premature deaths, falling narrowly short of the WHO targets. Nevertheless, achieving these gains relies on a dramatic scaling up of harm reduction interventions to people who inject drugs (to 40% coverage), continued reductions in risk of hepatitis C infection in the remaining population and implementation of screening programmes that result in 90% of hepatitis C infected people being diagnosed. Meeting global targets will only occur if concrete strategies are implemented at the local level. We worked with policy makers in Yunnan Province, China, to devise and assess a range of screening strategies. A combined suite of interventions could reduce incidence by 49% and mortality by 56% by 2030 with treatment costs over that period of 492 million Chinese Yuan. Targeted screening that averts future infections is more cost effective than general screening; cost effectiveness hinges upon reducing DAA costs below current list prices in China. Implementing hepatitis C interventions offers a net economic benefit. This work provides a two-sided view of tackling the public health burden of hepatitis C. Considered globally, significant steps towards elimination can be taken provided ambitious intervention targets are met. Considered locally, our analysis of the hepatitis C epidemic in Yunnan illustrates that interventions can be scaled up in a pragmatic way that offers economic benefits in addition to reducing the burden of disease ultimately borne by patients.
Supervisor: Hallett, Timothy ; Cooke, Graham ; Thursz, Mark ; Sicuri, Elisa Sponsor: Wellcome Trust
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral