Objective: Direct-acting antivirals have opened an opportunity for controlling hepatitis C virus (HCV) infection in Pakistan, where 10% of the global infection burden is found. We aimed to evaluate the implications of five treatment programme scenarios for HCV treatment as prevention (HCV-TasP) in Pakistan.
Design: An age-structured mathematical model was used to evaluate programme impact using epidemiological and programme indicators.
Setting: Total Pakistan population.
Participants: Total Pakistan HCV-infected population.
Interventions: HCV treatment programme scenarios from 2018 up to 2030.
Results: By 2030 across the five HCV-TasP scenarios, 0.6-7.3 million treatments were administered, treatment coverage reached between 3.7% and 98.7%, prevalence of chronic infection reached 2.4%-0.03%, incidence reduction ranged between 41% and 99%, program-attributed reduction in incidence rate ranged between 7.2% and 98.5% and number of averted infections ranged between 126 221 and 750 547. Annual incidence rate reduction in the first decade of the programme was around 6%-18%. Number of treatments needed to prevent one new infection ranged between 4.7-9.8, at a drug cost of about US$900. Cost of the programme by 2030, in the most ambitious elimination scenario, reached US$708 million. Stipulated WHO target for 2030 cannot be accomplished without scaling up treatment to 490 000 per year, and maintaining it for a decade.
Conclusion: HCV-TasP is a highly impactful and potent approach to control Pakistan's HCV epidemic and achieve elimination by 2030.
Keywords: Middle East and North Africa; incidence; mathematical model; prevalence; treatment as prevention.
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