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Modeling HCV/HIV Transmission and TasP in US network of PWID

Hepatitis C virus (HCV) and HIV, respectively, are the two most prevalent chronic viral infections. Among the 1.2 million people living with HIV, 25-30% are HCV/HIV coinfected, but HCV prevalence is highest (80.8%) among HIV+ people who inject drugs (PWIDs). With the availability of more tolerable and better HCV treatments, a Treatment as Prevention (TasP) approach could drastically tip the balance towards increased and potentially targeted HCV treatment approaches. Though eradicating HCV will require a strategic combination of prevention AND treatment, HCV treatment costs may become staggering and require strategic targeting of PWIDs - the only ones who can transmit virus. Treating PWIDs most effectively, however, requires a better understanding of injecting networks and understanding such structures may help guide informed treatment strategies.

The specific aims of this study are to:

1) Simulate injection networks using a measurement-calibrated network model of injection partnerships based on secondary data recently completed from a large, U.S. respondent-driven sample (RDS) of PWIDs

2) Develop a HCV dynamic transmission model that incorporates injection network structures and agent-based simulations to achieve two goals to:

a) analyze the effect of injection network structure on HCV incidence and prevalence

b) evaluate the effectiveness of various HCV TasP strategies within US PWID injection networks.

Funding Provided by: 
National Institute on Drug Abuse

Project Period: 
2016 - 2018

  • Professor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Affiliated Faculty, Yale Institute for Global Health; Director, Yale Center for Clinical and Community Research, Department of Medicine; Director, HIV in Prisons Program; Director, Community Health Care Van; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA)

    Frederick (Rick) L. Altice is a professor of Medicine, Epidemiology and Public Health and is a clinician, clinical epidemiologist, intervention and implementation science researcher at Yale University School of Medicine and School of Public Health. Dr. Altice’s primary research focuses on interventions and implementation science at the interface between infectious diseases and addiction and he has conducted research in several global health settings. He also has a number of projects working in the criminal justice system, including transitional programs addressing infectious diseases, medications for opioid use disorder (methadone, buprenorphine, extended release naltrexone), mental illness, homelessness and social instability. Specific topics include alcohol, opioid, stimulant and nicotine use disorders on HIV treatment outcomes, HIV and addiction treatment, interface with the criminal justice system, and pharmacokinetic drug interactions between treatment for substance use disorders and antiretroviral and tuberculosis therapy. At a basic level, his research focuses on clinical epidemiology, especially in key populations at risk for HIV (e.g., MSM, TGW, PWID, prisoners, sex workers) and development, adaptation and evaluation of of biomedical and behavioral interventions to improve treatment outcomes. His research, however, has evolved and included development and testing of mobile technologies (mHealth) to intervene with key populations to promote health outcomes.  His research is especially concentrated in health services research techniques with a focus on implementation science, seeking to introduce and scale-up evidence-based interventions in numerous contexts. A number of implementation science strategies are underway to examine scale-up of medication-assisted therapies to treat opioid use disorder in community, criminal justice and in primary care settings. Most recently, his work has been augmented through use of decision science techniques to understand and promote patient preferences, including the development of informed and shared decision-making aids. His work has emerged primarily with a global health focus with funded research projects internationally in Malaysia, Ukraine, Moldova, Armenia, Kyrgyzstan, Peru, and Indonesia. He has participated in projects through the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Agency, Special Projects of National Significance with HRSA, and the Center for Substance Abuse Treatment. He is currently also collaborating on projects with the WHO, UNAIDS, USAID, PEPFAR and UNODC. Current internationally funded projects in dedicated research sites that are being conducted in Malaysia, Ukraine, Moldova, Azerbaijan, Armenia, Kyrgyzstan and Peru. His research and training sites in Malaysia (2005), Peru (2010) and Ukraine (2005) are dedicated training and research sites for the Global Health Equity Scholars Fogarty Training Program and the Doris Duke International Fellowship program. He is currently the director for two International Implementation Science Research and Training Centers with collaborations between Yale University and the University of Malaya and Sichuan University.
  • Associate Research Scientist in Medicine (AIDS)

    Alexei Zelenev is a a research scientist and a faculty member at the Yale School of Medicine (AIDS program). His research has focused on the interplay of infectious diseases, substance abuse disorder and social networks. He obtained his BA from University of Chicago and his PhD from Yale University. He has advanced knowledge of survey design and implementation, applied statistics and simulation based methods. His research has appeared in such peer-reviewed journals as Lancet Infectious Diseases, Lancet HIV, International Journal of Drug Policy, Drug and Alcohol Dependence, AIDS and Behavior, among others. Dr. Zelenev served as an advisor to the Health Emergencies Program at the WHO. His infectious disease modeling work has been used to guide health policy in Ukraine and Kazakhstan during the height of the Covid pandemic.