Summary With recent advances in antiviral therapy, there is an opportunity to eliminate hepatitis C virus (HCV) from the UK population. HCV is common in incarcerated individuals, with previous estimates suggesting ~7% of the UK prison population is anti‐HCV antibody positive. Increasing diagnosis and treatment of HCV in prison is a priority in seeking to eliminate transmission in the general population. Thus the study aimed to assess the impact implementation of: (a) A universal offer of blood borne virus testing (UOBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; (b) Telemedicine clinics (TC) within North East England (NEE) prisons to increase HCV treatment rates. UOBBVT was initially implemented at Her Majesty's Prison (HMP) Durham, commencing March 2016. From March 2016 to February 2017, 2831 of 4280 (66%) new receptions were offered blood borne virus (BBV) testing. Of these, 1495 (53% of offered) accepted BBV testing, of whom 95 (6.4%) were HCV antibody positive, with 47 of those 95 (49.5%) HCV RNA positive, suggesting a prevalence of active infection in the tested population of 3.1% (95% CI 2.4%‐4.2%). Between August 2015 and October 2017, 80 individuals were seen in the TC and 57 (71%) commenced antiviral therapy. Of those with known outcome (n = 29), 100% achieved sustained virological response. In the year prior to implementation, only four patients received HCV treatment. In conclusion, a universal offer of BBV testing to inmates presenting at HMP reception coupled with linkage into specialist care via TC can substantially increase rates of testing, diagnosis and treatment of HCV in this high‐prevalence population.
To achieve elimination of hepatitis C (HCV), a critical group to prioritise for diagnosis and treatment is the prison population, where HCV prevalence is high. A universal offer of blood‐borne virus testing (UOBBVT) programme and a new treatment pathway were introduced to seven North East England (NEE) Prisons. Our aim was to assess: (a) the proportion of individuals with active HCV commencing direct‐acting antivirals (DAAs); (b) the outcomes following DAA treatment; (3) the reinfection rate following sustained virological response (SVR). Data were collected prospectively on BBVT uptake, HCV positivity, HCV treatment outcomes and reinfection from March 2016 onwards. 8538 individuals had BBV testing. In total, 612 (7.2%) and 374 (4.4%) were HCV antibody positive and HCV RNA positive, respectively. Ultimately, 266 (71%) individuals commenced DAAs. Overall 111 achieved a documented SVR (42%), 17 (6%) failed treatment, 30 (11%) were still on treatment or had not reached 12 weeks post‐treatment at time of analysis, and 108 (41%) were lost to follow‐up. In those with a known outcome (n = 128), 87% achieved SVR. Worryingly, of those who achieved SVR, 21 (19%) were subsequently identified as having been reinfected (median time from SVR to documented reinfection 13 (range 7‐25) months). The reinfection rate was 0.406 cases per person‐year follow‐up. In conclusion, Implementation of a UOBBVT programme and new treatment pathway resulted in increased diagnosis and treatment of HCV in the NEE prison population. However, the high HCV reinfection rate suggests a need to improve harm reduction approaches.
Those who did not receive PRC transfusions or were transfused as outpatients or a semi-elective day case setting were excluded.
Ideo G, et al. Randomised trial of interferon alfa2b plus ribavirin versus interferon alfa2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT).
discomfort and two with worry about abdominal symptoms. Items that loaded onto factor two were concerned with fear that symptoms were caused by a serious underlying illness. Items loading onto factor three were concerned with the fear of symptoms in the context of new experiences, for example trying new foods or having access to toilets in places that someone hasn't visited before. Both factor one of the VSI and the PHQ-12 were strongly and independently associated with IBS symptom severity, for the group as a whole (p < 0.001), and for all four IBS subtypes. However, factors two and three of the VSI were not significantly associated with IBS symptom severity. Of note, most VSI items concerned with overt gastrointestinal symptom-specific anxiety loaded onto these two factors that were not associated with IBS symptom severity. Conclusions The factor structure of the VSI requires further investigation. Our findings cast doubt on the central role of gastrointestinal symptom-specific anxiety as a driver for symptom severity in IBS. Awareness of both gastrointestinal and extra-intestinal symptoms, however, is strongly associated with symptom severity.
IntroductionDue to a higher prevalence of intravenous drug use among offenders, prisons may have a higher prevalence of HCV than community, managing HCV and ensuring successful therapy may be more challenging in such settings.1 Durham has one of the largest prison populations in the UK. NICE endorsed therapy with pegylated interferon and ribavarin is recommended with reported rates of sustained viral response (SVR) of 75–85% with 6 months and 40–50% with 12 months therapy for genotypes 2/3 and 1, respectively.2 A new service was set up at University Hospital of North Durham in January 2008 to improve provision of HCV care within the NHS and the local prisons with a nurse led inreach service in prisons.MethodsThe aim of the study was to audit treatment outcomes of referrals to the HCV service in County Durham with current NICE guideline. Data were collected prospectively from January 08 using a computerised database.ResultsThere were 120 referrals from January 3008 to September 2009; at time of abstract submission, follow-up data on SVR were available for those commenced on treatment between Jan to Dec 2008, data on these 59 HCV PCR positive patients including 47 prisoners are presented. 15 prisoners were unable to complete therapy as they were lost to follow-up following transfer/release from prisons in Durham. Reasons for not treating included patient refusal in 3 and DNAs of GP referrals and prisoners transferred elsewhere prior to start of therapy in 14 (Abstract 054). Abstract PWE-054Results of HCV therapyTotal treatedPrisoners treatedCommunity treatedNo HCV PCR positive594712No Commenced HCV Rx42/59 (71%)35/47 (74%)7/12 (58%)No completed HCV Rx25/42 (69%)21/35 (60%)4/7* (57%)SVR for Geno 2+3 with completed Rx18/18 (100%)14/14 (100%)4/4 (100%)SVR for Geno 1 with completed Rx6/7 (87%)6/7 (87%)Not applicable*2 patients on 72-week treatment due to slow response. ConclusionApproximately three quarters of all HCV referrals were suitable for therapy; SVR of 100% and 86% were observed in those with genotype 2/3 and 1, respectively, who completed treatment, these outcomes are superior to those reported in NICE and were similar in prisoners and community referrals. There data suggest that while treatment outcomes for prisoners with HCV are similar to those treated in the community, the main obstacle in treating prisoners is ensuring therapy is completed as prisoners are lost to follow-up, in up to a quarter of cases due to transfers/ release. These findings indicate a need to improve the pathway for ensuring complete follow-up of this patient group.
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