UC San Diego

Objectives: We use dynamic epidemic modeling to determine what level of treatment scale-up and targeting strategy is required to achieve the Eliminate Hepatitis C San Diego County Initiative goals: 1)80% reduction in hepatitis C virus (HCV) incidence and 2)65% reduction in HCV-related mortality by 2030.Methods: A dynamic, deterministic, compartmental HCV transmission model was developed and stratified by population group risk (people who inject drugs (PWID), men who have sex with men (MSM), and the general population, each further stratified by gender and HIV infection status [positive/negative] for a total of 10 population groups), HCV infection/disease progression status, and age. Transmission rates among MSM and PWID were calibrated to 2018 seroprevalence estimates in these groups, and the model was initialized in 2018 with an estimated 55,354 people with a history of HCV infection in San Diego County. Baseline treatment was 5%/year from 2018, and scenarios were selected to examine the level of scale-up required after 2021 to achieve the incidence and mortality targets among different subpopulations. Results: The HCV-related mortality reduction target of a 65% reduction was met at baseline and all intervention scenarios. The incidence elimination target was met among MSM using a lower treatment rate of 21.6%/year, and among PWID using a slightly higher treatment rate of 34.5%/year. Conclusion: San Diego County is on track to achieve its HCV-related mortality elimination target, but in order to achieve the HCV incidence elimination goal, treatment scale-up is required among those especially at risk of transmission, such as MSM and PWID.