OBJECTIVE To describe an injecting network of PWID living in an isolated community on the Isle of Wight (UK) and the results of a agent-based simulation, testing the effect of Hepatitis C (HCV) treatment on transmission. METHOD People who inject drugs (PWID) were identified via respondent driven sampling and recruited to a network and bio-behavioural survey. The injecting network they described formed the baseline population and potential transmission pathways in an agent-based simulation of HCV transmission and the effects of treatment over 12 months. RESULTS On average each PWID had 2.6 injecting partners (range 0-14) and 137 were connected into a single component. HCV in the network was associated with a higher proportion of positive injecting partners (p = 0.003) and increasing age (p = 0.011). The treatment of well-connected PWID led to significantly fewer new infections of HCV than treating at random (10 vs. 7, p<0.001). In all scenarios less than one individual was re-infected. CONCLUSION In our model the preferential treatment of well-connected PWID maximised treatment as prevention. In the real-world setting, targeting treatment to actively injecting PWID, with multiple injecting partners may therefore represent the most efficient elimination strategy for HCV.

中文翻译：

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在多个注射对象的人群中优先进行丙型肝炎治疗可最大程度地提高预防效果：一项现实世界的网络研究。

目的描述生活在怀特岛（英国）一个孤立社区中的PWID注射网络以及基于代理的模拟结果，测试丙型肝炎（HCV）治疗对传播的影响。方法通过响应者驱动的抽样确定注射毒品者（PWID），并将其招募到网络和生物行为调查中。他们描述的注射网络形成了基于人群的HCV传播模拟和12个月内治疗效果的基线人群和潜在的传播途径。结果平均每个PWID具有2.6个注射伙伴（范围0-14），并且137个连接到单个组件中。网络中的HCV与更高比例的阳性注射伴侣（p = 0.003）和年龄增加（p = 0.011）相关。与随机治疗相比，连接良好的PWID导致的HCV新感染明显减少（10 vs. 7，p <0.001）。在所有情况下，只有不到一个人被重新感染。结论在我们的模型中，对联系良好的PWID的优先治疗将最大程度的预防作为治疗。因此，在现实世界中，针对具有多个注射对象的主动注射PWID进行治疗可能是代表最有效的HCV消除策略。