Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis

Carlos D Rivera Saldana; Daniela Abramovitz; Leo Beletsky; Annick Borquez; Susan Kiene; Lara K Marquez; Thomas Patton; Steffanie Strathdee; María Luisa Zúñiga; Natasha K Martin; Javier Cepeda

doi:10.1111/add.16203

Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis

Addiction. 2023 Sep;118(9):1763-1774. doi: 10.1111/add.16203. Epub 2023 May 1.

Authors

Affiliations

¹ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA.
² School of Public Health, San Diego State University, San Diego, California, USA.
³ School of Law and Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA.
⁴ School of Social Work, San Diego State University, San Diego, California, USA.
⁵ Population Health Sciences, University of Bristol, Bristol, UK.
⁶ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PMID: 37039246
PMCID: PMC10524658 (available on 2024-09-01)
DOI: 10.1111/add.16203

Abstract

Background and aims: Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana.

Methods: We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016-2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention.

Results: Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3-29.7/100py) in 2016 to 21.1/100py (UI = 15.0-29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0-27.8/100py) by 2026 and avert 186 (32-389) new infections, 76 (UI = 12-160) cases of cirrhosis and 32 (5-73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon.

Conclusions: In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.

Keywords: Epidemic modelling; HCV; PWID; Tijuana; incarceration; police education.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cost of Illness
Drug Users*
Hepacivirus
Hepatitis C* / epidemiology
Humans
Mexico / epidemiology
Police
Seroepidemiologic Studies
Substance Abuse, Intravenous* / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding