Helping national decision-makers, program managers, and funding partners achieve maximum impact with the funding available for the country's public health response and plan for sustainability.

Hepatitis C virus (HCV) infection is a global health problem; about 80-100 million individuals worldwide are chronically infected and at risk for progressive liver disease.

The landscape of HCV prevention and control is changing rapidly. Until recently, HCV elimination seemed an unrealistic public health goal with interferon-based therapies having moderate (60-70%) success rates, being arduous (6-12 months) to take, having side-effects, and they are contraindicated in decompensated cirrhosis, where mortality risk is highest. However, there is much excitement around the major advancement of interferon-free direct-acting antiviral (DAA) treatment regimens, which offer short-duration (8-12 weeks) therapy, are tolerable, simple (once- daily), and have high efficacy (cure >90%, even in advanced liver disease). Given that DAA therapy can halt progression of liver disease and reverse fibrosis, the rapid scale-up of IFN-free DAA therapy could lead to substantial reductions in HCV-related hospitalizations, hepatocellular carcinoma (HCC) and death. Elimination targets are now being considered globally.

Aims of Optima HCV

Numerous policy, program and research questions can be addressed with Optima. The primary questions able to be addressed by this tool will be:

  • How should the HCV response prioritize investment across population groups by different geographical areas, and which service delivery modalities and mechanisms, to get as close as possible to national strategic plan targets with available resources?
  • What have been the impacts of past prevention and treatment program implementation? Specifically, how would the country's past HCV epidemic trajectories have changed (difference in new infections and deaths) had investment not occurred?

There are several other policy considerations and specific research questions that can be answered with an Optima HCV model.

What is the impact of current prevention and treatment programs, over different time horizons, on HCV incidence and disease burden (fibrosis, cirrhosis and liver cancer)?

  • With the recent or proposed launch of ambitious treatment programs in some countries, it is important to assess the impact on averting HCV transmission in the population (impact of "treatment for prevention"). This is of interest to assess effectiveness, cost-effectiveness, and averted infections over different time horizons.

What is the expected future impact of policy or program implementation scenarios?

  • What is the impact of interventions such as replacing conventional syringes with smart syringes, or improving screening of blood units, on HCV incidence?
  • What is the impact of different prioritization schemes such as prioritization by:
    • age group (birth cohort screening);
    • disease progression;
    • geography; or
    • specific risk populations, such as screening and treating pregnant women to prevent mother to child transmission, or screening and treating injecting drug users to prevent transmission through injecting equipment sharing.
  • What is the opportunity cost of delaying treatment scale-up on preventable infections and future disease burden?

How close are we to National Strategic Plan targets under current funding?

  • With current programs, expenditure and funding allocation, how close will the country get to their National Strategic Plan's disease-related targets?
  • What if the current volume of funding were allocated optimally?

How much funding is required to achieve the national or global targets?

  • Over a specified program period, according to current program implementation practices and costs:
    • How much total funding is required to meet national or global targets?
    • How is this funding optimally allocated between programs?

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