BACKGROUND & AIMS: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. METHODS: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. RESULTS: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. CONCLUSIONS: The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. LAY SUMMARY: Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).

Aix Marseille Univ INSERM IRD SESSTIM Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale Marseille France; ORS PACA Observatoire Régional de la Santé Provence Alpes Côte d'Azur Marseille France

Department of Medicine Huddinge Division of Infectious Diseases Karolinska Institutet Karolinska University Hospital Stockholm Sweden

Division of Global Public Health University of California San Diego San Diego CA USA; Population Health Sciences Bristol Medical School University of Bristol Bristol UK

French Institute for Public Health Surveillance St Maurice France; CERMES3 Paris France

Glasgow Caledonian University Glasgow Scotland UK; Health Protection Scotland Glasgow Scotland UK

Health Protection Scotland Glasgow Scotland UK

HealthNorth Bremen Germany; University of Hamburg Hamburg Germany

National Institute for Health and Welfare Helsinki Finland

National Monitoring Centre for Drugs and Drug Addiction Prague Czech Republic; Charles University and General University Hospital Prague Prague Czech Republic; National Institute of Mental Health Klecany Czech Republic

Odense University Hospital Odense Denmark

Population Health Sciences Bristol Medical School University of Bristol Bristol UK

Public Health Service of Amsterdam Amsterdam The Netherlands

Public Health Service of Amsterdam Amsterdam The Netherlands; Academic Medical Centre University of Amsterdam Amsterdam The Netherlands

Public Health Service of Amsterdam Amsterdam The Netherlands; University Medical Center Utrecht Utrecht The Netherlands

Robert Koch Institute Berlin Germany

University of Dundee Dundee Scotland UK

University of Hamburg Hamburg Germany

University of Ljubljana Ljubljana Slovenia; University Medical Centre Ljubljana Ljubljana Slovenia

University of Oslo Oslo Norway

University of Oslo Oslo Norway; Akershus University Hospital Lørenskog Norway

Ziekenhuis Oost Limburg Genk Belgium; Hasselt University Diepenbeek Belgium; University Hospital Leuven Leuven Belgium

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