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Modelling suggests that more frequent screening of people who inject drugs (PWID) and an improved care cascade are required to achieve the WHO hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030. We determined the testing frequencies (two-yearly, annually, six-monthly, three-monthly) and retention in care required among PWID to achieve the HCV incidence reduction target through treatment-as-prevention in low (25%), medium (50%) and high (75%) chronic HCV prevalence settings. Mathematical modelling of HCV transmission among PWID, capturing testing, treatment and other features of the care cascade were employed. In low prevalence settings, two-yearly antibody testing of PWID was estimated to reach the elimination target by 2027-2030 depending on retention in care, with annual testing reducing the time by up to three years. In medium prevalence settings, if close to 90% testing coverage were achieved then annual antibody testing of PWID would be sufficient. If testing coverage were lower (80%), six-monthly antibody testing with at least 70% retention in care or annual HCV RNA/cAg testing would be required. In high prevalence settings, even three-monthly HCV RNA/cAg testing of PWID alone was unable to achieve the incidence reduction target. Thus, for geographical areas or sub-populations with high prevalence, WHO incidence targets are unlikely to be met without three-monthly RNA testing accompanied by other prevention measures. Novel testing strategies, such as rapid point-of-care antibody testing or replacing antibody testing with RNA tests as a screening tool, can provide additional population-level impacts to compensate for imperfect follow-up or testing coverage. This article is protected by copyright. All rights reserved.
The authors gratefully acknowledge the support to the Burnet Institute provided by the Victorian Government Operational Infrastructure Support Program. RSD, AP, JD, AT and MH are the re-cipients of National Health and Medical Research Council fellowships/