BACKGROUND & AIMS In Iceland a nationwide program has been launched offering direct-acting antiviral (DAA) treatment for everyone living with hepatitis C virus (HCV). We estimate (i) the time and treatment scale-up required to achieve the World Health Organization's HCV elimination target of an 80% reduction in incidence; and (ii) the ongoing frequency of HCV testing and harm reduction coverage among people who inject drugs (PWID) required to minimize the likelihood of future HCV outbreaks occurring. METHODS We used a dynamic compartmental model of HCV transmission, liver disease progression and the HCV cascade of care, calibrated to reproduce the epidemic of HCV in Iceland. The model was stratified according to injecting drug use status, age and stage of engagement. Four scenarios were considered for the projections. RESULTS The model estimated that an 80% reduction in domestic HCV incidence was achievable by 2030, 2025 or 2020 if a minimum of 55/1,000, 75/1,000 and 188/1,000 PWID were treated per year, respectively (a total of 22, 30 and 75 of the estimated 400 PWID in Iceland per year, respectively). Regardless of time frame, this required an increased number of PWID to be diagnosed to generate enough treatment demand, or a 20% scale-up of harm reduction services to complement treatment-as-prevention incidence reductions. When DAA scale-up was combined with annual antibody testing of PWID, the incidence reduction target was reached by 2024. Treatment scale-up with no other changes to current testing and harm reduction services reduced the basic reproduction number of HCV from 1.08 to 0.59, indicating that future outbreaks would be unlikely. CONCLUSION HCV elimination in Iceland is achievable by 2020 with some additional screening of PWID. Maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that outbreaks are unlikely to occur once elimination targets have been reached. LAY SUMMARY In Iceland, a nationwide program has been launched offering treatment for the entire population living with hepatitis C virus (HCV). A mathematical model was used to estimate the additional health system requirements to achieve the HCV elimination targets of the World Health Organization (WHO), as well as the year that this could occur. With some additional screening of people who inject drugs, Iceland could reach the WHO targets by 2020, becoming one of the first countries to achieve HCV elimination. The model estimated that once elimination targets were reached, maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that future HCV outbreaks are unlikely to occur.

中文翻译：

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建模在冰岛消除丙型肝炎作为公共卫生威胁：到 2020 年可实现的目标

背景与目标 在冰岛，一项全国性计划已启动，为每个丙型肝炎病毒 (HCV) 感染者提供直接作用抗病毒 (DAA) 治疗。我们估计 (i) 实现世界卫生组织将发生率降低 80% 的 HCV 消除目标所需的时间和治疗规模；(ii) 在注射吸毒者 (PWID) 中持续进行 HCV 检测和减少危害覆盖率，以尽量减少未来发生 HCV 爆发的可能性。方法 我们使用了 HCV 传播、肝病进展和 HCV 级联护理的动态区室模型，经过校准以重现冰岛的 HCV 流行。该模型根据注射吸毒状况、年龄和参与阶段进行分层。预测时考虑了四种情况。结果 该模型估计，如果每年分别治疗至少 55/1,000、75/1,000 和 188/1,000 的 PWID（总共 22、30和冰岛每年估计 400 名 PWID 中的 75 名）。无论时间框架如何，这都需要更多的 PWID 被诊断出来以产生足够的治疗需求，或者将减少危害服务的规模扩大 20% 以补充治疗即预防发生率的减少。当 DAA 规模扩大与 PWID 的年度抗体检测相结合时，到 2024 年就实现了降低发病率的目标。 在当前检测和减少危害服务没有其他变化的情况下，扩大治疗规模将 HCV 的基本繁殖数从 1.08 降低到 0.59，表明未来不太可能爆发。结论 通过对 PWID 进行一些额外筛查，到 2020 年可以在冰岛实现 HCV 消除。维持当前的监测和减少危害服务，同时为被诊断出患有 HCV 的人提供持续的 DAA 治疗，将确保一旦达到消除目标就不太可能发生疫情。概述 在冰岛，已经启动了一项全国性计划，为所有丙型肝炎病毒 (HCV) 感染者提供治疗。使用数学模型来估计实现世界卫生组织 (WHO) 消除 HCV 目标所需的额外卫生系统要求，以及可能发生的年份。通过对注射吸毒者进行一些额外的筛查，冰岛可以在 2020 年之前达到世卫组织的目标，成为首批实现消除丙肝病毒的国家之一。