7. PROJECT SUMMARY/ABSTRACT
Hepatitis C (HCV) is a leading cause of chronic liver disease and mortality worldwide. The World Health
Organization (WHO) has recently recognized the need to prevent and control HCV infection, and proposed that
HCV elimination is feasible by 2030 by reducing new chronic infections by 90% and HCV-related mortality by
65%. In the U.S., elimination strategies are urgently needed that focus on persons who inject drugs (PWID), the
group at most risk for acquiring and transmitting HCV infection. Despite the long-term availability of harm
reduction strategies such as syringe exchange programs (SEP), opioid substitution therapies (OSTs), and
behavioral counseling, HCV incidence in the U.S. is on the rise among PWID. The recent availability of all oral
direct-acting antivirals (DAAs) with high reported cure rates (e.g., >90%) that can prevent liver disease
progression and HCV transmission, combined with prevention and harm reduction strategies, make HCV
elimination an attainable goal. However, given considerable barriers (e.g., cost of DAAs, poor linkage to care
and adherence, possible reinfection, PWID lifestyle), it is essential for policy development and strategic planning
to understand the factors that would most effectively promote HCV elimination among PWID. Understanding the
dynamic and complex interplay of factors at the individual (e.g., risk behaviors), social (e.g., injection networks),
structural (e.g., access to syringe exchange programs and opioid substitution therapies), and geographic (e.g.,
non-urban residence) levels is essential to improve understanding and development of HCV elimination
strategies. Current models cannot account for such dynamic and complex interactions. As such we propose to
develop a comprehensive, data-driven agent-based model for Hepatitis C Elimination in PWID (HepCEP) using
the Chicago PWID population as a template and proof of concept that would enable policy makers to identify the
most effective intervention strategies for elimination of HCV by 2030 based on the aforementioned WHO's
proposed reduction estimates. The long term significance of these efforts would be to adapt the HepCEP
framework to (i) model HCV transmission in the general population of Chicago and in Illinois prisons, (ii) forecast
the spread of HCV in other U.S. urban and non-urban PWID populations (e.g., Albuquerque, NM), (iii) perform
cost-effectiveness analyses, and (iv) assist vaccine-trial sponsors in designing and evaluating clinical trials.