减少注射吸毒者丙型肝炎和肝硬化的联合干预措施：一项基于代理人的网络人群模拟实验
Combination interventions for Hepatitis C and Cirrhosis reduction among people who inject drugs: An agent-based, networked population simulation experiment
摘要：
丙型肝炎病毒（HCV）感染在注射毒品（PWID）人群中流行，在美国PWID的患病率估计超过60%。先前的建模研究表明，直接作用的抗病毒药物（DAA）治疗可以降低该人群的总体患病率，但由于成本原因，治疗通常延迟至晚期肝病（纤维化3期或更晚）发作。以注射器接入（SA）和药物辅助治疗（MAT）为特征的低成本干预措施已知成本较低，但在将HCV感染率降低到目前水平以下方面显示出好坏参半的结果。关于DAA和MAT联合治疗的潜在协同效应知之甚少，联合干预的大规模试验也很少见。虽然模拟实验可以揭示可能的长期影响，但大多数先前的模拟都是在封闭的模型代理人群上进行的-这种情况与大多数卫生机构所知的开放，移动人群完全不同。本文使用来自疾病控制中心的国家艾滋病毒行为监测项目，IDU第3轮，由纽约市卫生和心理卫生局于2012年在纽约市收集的数据，对开放人群进行参数化模拟。我们的研究结果表明，在一个开放的人群中，SA/MAT本身对HCV的患病率只有很小的影响，而DAA治疗本身可以显着降低HCV和HCV相关的晚期肝病的患病率。更重要的是，模拟实验表明，这两种策略的成本效益协同组合可以显着降低HCV的发病率。我们的结论是，采用SA/MAT实施与DAA干预措施可以在减少持续感染的长期后果方面发挥关键作用。
英文摘要：
Hepatitis C virus (HCV) infection is endemic in people who inject drugs (PWID), with prevalence estimates above 60 percent for PWID in the United States. Previous modeling studies suggest that direct acting antiviral (DAA) treatment can lower overall prevalence in this population, but treatment is often delayed until the onset of advanced liver disease (fibrosis stage 3 or later) due to cost. Lower cost interventions featuring syringe access (SA) and medically assisted treatment (MAT) for addiction are known to be less costly, but have shown mixed results in lowering HCV rates below current levels. Little is known about the potential synergistic effects of combining DAA and MAT treatment, and large-scale tests of combined interventions are rare. While simulation experiments can reveal likely long-term effects, most prior simulations have been performed on closed populations of model agents--a scenario quite different from the open, mobile populations known to most health agencies. This paper uses data from the Centers for Disease Control's National HIV Behavioral Surveillance project, IDU round 3, collected in New York City in 2012 by the New York City Department of Health and Mental Hygiene to parameterize simulations of open populations. Our results show that, in an open population, SA/MAT by itself has only small effects on HCV prevalence, while DAA treatment by itself can significantly lower both HCV and HCV-related advanced liver disease prevalence. More importantly, the simulation experiments suggest that cost effective synergistic combinations of the two strategies can dramatically reduce HCV incidence. We conclude that adopting SA/MAT implementations alongside DAA interventions can play a critical role in reducing the long-term consequences of ongoing infection.
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