1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
2 Division of Medical Affairs, Grady Health System, Atlanta, Georgia, USA.
3 RTI International, Research Triangle Park, USA.
4 Institute for Global Health Sciences, University of California San Francisco, San Francisco, USA.
5 Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Kentucky, USA.
6 Department of Epidemiology, University of Kentucky College of Public Health, Kentucky, USA.
7 Division of HIV/AIDS Prevention (DHAP), U.S. Centers for Disease Control and Prevention, Atlanta, USA.
8 Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, USA.
9 Department of Chemistry, University of Colorado, Denver, USA.
10 Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA.
11 Center for Public Health Research, Population Health Division, San Francisco Department of Public Health, 25 Van Ness Ave. San Francisco CA, USA.
12 Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, USA.
13 Coalition for Global Hepatitis Elimination, Task Force for Global Health, Georgia, USA.
In the U.S. Hepatitis C virus (HCV) transmission is increasing among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modelling, we investigate the impact of scaling-up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky (PC), and San Francisco, California (SF), where HCV sero-prevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban SF (established community) than rural PC (young, expanding community). We model the proportion of HCV-infected PWID needing HCV-treatment annually to reduce HCV-incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (PC only) from 2017. With current MAT&SSP coverage during 2017-2030, HCV-incidence will increase in PC (21.3 to 22.6 per 100 person-years (/100pyrs)) and decrease in SF (12.9 to 11.9/100pyrs). With concurrent MAT&SSP scale-up, 5%/year of HCV-infected PWID need HCV-treatment in PC to achieve incidence targets; 13%/year without MAT&SSP scale-up. In SF, a similar proportion need HCV-treatment (10%/year) irrespective of MAT scale-up. Reaching the same impact by 2025 requires increases in treatment rates of 45-82%. Achievable provision of HCV-treatment, alongside MAT&SSP scale-up (PC) and MAT scale-up (SF), could reduce HCV-incidence.