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HCV Transmission and Tattoo Parlors

HCV Transmission and Tattoo Parlors. Is it cost-effective to regulate tattoo parlors to reduce the spread of HCV? At what prevalence level is it cost-effective?. HCV. 3.1% of world infected with HCV 20% of recruits in Egypt Expected to kill more Americans than HIV Transmitted through blood

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HCV Transmission and Tattoo Parlors

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  1. HCV Transmission and Tattoo Parlors • Is it cost-effective to regulate tattoo parlors to reduce the spread of HCV? • At what prevalence level is it cost-effective?

  2. HCV • 3.1% of world infected with HCV • 20% of recruits in Egypt • Expected to kill more Americans than HIV • Transmitted through blood • Transfusions, sex, mother-child, unsterilized medical equipment, injection drug use, … • Most frequently through needle sharing(developed countries) • Transfusion now screened • What about tattooing? • Conflicting data.

  3. Model • Compartmental infectious disease model • With costly control • Similar to HIV but • HCV more infectious • HCV infection less costly • Considers both tattoo and non-tattoo modes of transmission • Not additive

  4. States • 3 health states • S = Susceptibles • A = Acute infection • C = Chronic infection • 2 social states • t = visits tattoo parlors • o = doesn’t • 6 total states: So,St,Ao,At,Co,Ct

  5. Non-tattooed population • A, C death rates • rAS, rAC, rCS transition rates • S death+turning 50 •  = overall prevalence •  rate of non-tattoo transmission • Time in years • Population = age 15-50 s So rCS rAS  rAC Ao Co A C

  6. s • k = flow of people turning 15 • g = rate at which people not interested in tattoos •  = annual rate of getting tattoos

  7.  = P(infection | infected equipment) •  = P(equipment infected) = ·f(t) •  = P(use of equipment on HCV+ person infects equipment) • f(t) = P(use of equipment on HCV+ person) • Typically equipment used 5 times before replaced • f(t) = (1/5) ∑i=0..4 1-(1-t)i

  8. s t=(At+Ct)/(St+At+Ct) =(Ao+At+Co+Ct)/total

  9. Control • Control is sterilization of equipment •  = 0 (or close to) • Time •  = time of regulation • T = planning horizon (15 years in baseline) • Discounting (3% in baseline) • Outcomes • (,T) = total discounted number of sterilizations • I(,T) = total discounted number of infections

  10. Cost-effectiveness • Cost •  = cost of sterilization •  = cost infection • Not really accounting for health quality • Regulate at time t2 versus t1 • Benefit/Cost ratio [$]/[$] • BC(t1,t2) = (I(t2,T)-I(t1,T))/(S(t2,T)-S(t1,T)) ·/

  11. Base Case

  12. Uncertainty in 

  13. Is a dynamic model needed?

  14. Conclusion and Discussion • Regulating tattoo parlors is cheap and cost-effective • Doesn’t capture averted secondary infections beyond horizon • More tattoos () may decrease BC • Dynamic model crucial to capturing secondary infections • Would an age structured model make sense? • What about HIV?

  15. Next Time Network models: the effect of reducing concurrency on HIV transmission…

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