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Treatment as prevention for hepatitis C virus in Pakistan: mathematical modelling projections
  1. Houssein H Ayoub1,
  2. Laith J Abu-Raddad2,3,4
  1. 1 Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
  2. 2 Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
  3. 3 Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, USA
  4. 4 College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
  1. Correspondence to Dr Houssein H Ayoub; hayoub{at} and Dr Laith J Abu-Raddad; lja2002{at}


Objective Direct-acting antivirals have opened an opportunity for controlling hepatitis C virus (HCV) infection in Pakistan, where 10% of the global infection burden is found. We aimed to evaluate the implications of five treatment programme scenarios for HCV treatment as prevention (HCV-TasP) in Pakistan.

Design An age-structured mathematical model was used to evaluate programme impact using epidemiological and programme indicators.

Setting Total Pakistan population.

Participants Total Pakistan HCV-infected population.

Interventions HCV treatment programme scenarios from 2018 up to 2030.

Results By 2030 across the five HCV-TasP scenarios, 0.6–7.3 million treatments were administered, treatment coverage reached between 3.7% and 98.7%, prevalence of chronic infection reached 2.4%–0.03%, incidence reduction ranged between 41% and 99%, program-attributed reduction in incidence rate ranged between 7.2% and 98.5% and number of averted infections ranged between 126 221 and 750 547. Annual incidence rate reduction in the first decade of the programme was around 6%–18%. Number of treatments needed to prevent one new infection ranged between 4.7–9.8, at a drug cost of about US$900. Cost of the programme by 2030, in the most ambitious elimination scenario, reached US$708 million. Stipulated WHO target for 2030 cannot be accomplished without scaling up treatment to 490 000 per year, and maintaining it for a decade.

Conclusion HCV-TasP is a highly impactful and potent approach to control Pakistan’s HCV epidemic and achieve elimination by 2030.

  • incidence
  • prevalence
  • mathematical model
  • treatment as prevention
  • Middle East and North Africa

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  • Contributors HHA designed the mathematical model, conducted the analyses and wrote the first draft of the paper. LJA-R conceived and led the design of the study and model, analyses and drafting of the article. All authors have read and approved the final manuscript.

  • Funding This publication was made possible by NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation). The findings achieved herein are solely the responsibility of the authors. The authors are also grateful for support provided by the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine-Qatar.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Patient consent for publication Not required.

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