{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:37:23Z","timestamp":1791488243056,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R36\u2010DA052224"],"award-info":[{"award-number":["R36\u2010DA052224"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01\u2010DA036297"],"award-info":[{"award-number":["U01\u2010DA036297"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01\u2010DA048063"],"award-info":[{"award-number":["R01\u2010DA048063"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2327751"],"award-info":[{"award-number":["2327751"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Although previous modelling work indicates treatment of &lt;\u200910 people who inject drugs (PWID) per 100 person\u2010years (PY) could achieve hepatitis C virus (HCV) elimination targets in many settings, these models frequently make simplifying assumptions of heterogeneity in infection risk. Here, we evaluated the impact of incorporating risk heterogeneity in transmission models on the predicted effects of interventions and the feasibility of HCV elimination in high\u2010burden settings. We built an individual\u2010based model of HCV transmission informed by detailed data from a cohort of PWID in Baltimore, MD, including an individual\u2010 and time\u2010varying risk multiplier on the force of infection. We contrasted these risk\u2010informed models to risk\u2010agnostic models, ignoring this heterogeneity, and explored various levels of treatment and harm reduction scale\u2010up from 2020 to 2030. Risk\u2010agnostic models routinely estimated greater reductions in incidence (8%\u201319% higher for treatment rates of 10\u201390 per 100 PY) and greater numbers of infections averted per treatment course compared to otherwise equivalent populations modelled with risk heterogeneity. Elimination targets were only achieved in risk\u2010informed models when treating 90 PWID per 100 PY. Expanding harm reduction services dramatically improved the impact of elimination programs, particularly in averting new infections soon after treatment scale\u2010up initiation. Achieving HCV elimination targets among PWID in high\u2010burden settings will require substantial improvements in treatment access and harm reduction services. Models that ignore the unequal distribution of HCV risk, including the correlation between reinfection risk and onward transmission, can result in inappropriately optimistic estimates of the feasibility of elimination.<\/jats:p>","DOI":"10.1111\/jvh.70096","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T19:25:28Z","timestamp":1760556328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Risk Heterogeneity on the Feasibility of Hepatitis C Elimination Among People Who Inject Drugs: A Modelling Study"],"prefix":"10.1111","volume":"32","author":[{"given":"Kyra H.","family":"Grantz","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek A. T.","family":"Cummings","sequence":"additional","affiliation":[{"name":"Department of Biology and Emerging Pathogens Institute University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Mier\u2010y\u2010Teran","family":"Romero","sequence":"additional","affiliation":[{"name":"Leidos Supporting the Administration for Strategic Preparedness and Response  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Astemborski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Kirk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier A.","family":"Cepeda","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti H.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Wesolowski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840360706"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30085-8"},{"key":"e_1_2_8_4_1","unstructured":"\u201cCombating Hepatitis B and C to Reach Elimination by 2030 \u201d(2016) https:\/\/www.who.int\/publications\/i\/item\/combating\u2010hepatitis\u2010b\u2010and\u2010c\u2010to\u2010reach\u2010elimination\u2010by\u20102030."},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21-3846"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.08.001"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(18)30304-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtbi.2018.11.013"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00077-7"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00267-9"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.13948"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.915"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.12.013"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30483-8"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12859"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27403"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13999"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac272"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq441"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15659"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268818002042"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2018.02.003"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13661"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.10.010"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26431"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.13764"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2256-5"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0078286"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12975"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0207226"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-01862-6"}],"container-title":["Journal 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