A matched comparison study of hepatitis C treatment outcomes in the prison and community setting, and an analysis of the impact of prison release or transfer during therapy

Abstract

Summary Prisoners are a priority group for hepatitis C (HCV) treatment. Although treatment durations will become shorter using directly acting antivirals (DAAs), nearly half of prison sentences in Scotland are too short to allow completion of DAA therapy prior to release. The purpose of this study was to compare treatment outcomes between prison- and community-based patients and to examine the impact of prison release or transfer during therapy. A national database was used to compare treatment outcomes between prison treatment initiates and a matched community sample. Additional data were collected to investigate the impact of release or transfer on treatment outcomes. Treatment-naïve patients infected with genotype 1/2/3/4 and treated between 2009 and 2012 were eligible for inclusion. 291 prison initiates were matched with 1137 community initiates: SVRs were 61% (95% CI 55%–66%) and 63% (95% CI 60%–66%), respectively. Odds of achieving a SVR were not significantly associated with prisoner status (P=.33). SVRs were 74% (95% CI 65%–81%), 59% (95% CI 42%– 75%) and 45% (95% CI 29%–62%) among those not released or transferred, transferred during treatment, or released during treatment, respectively. Odds of achieving a SVR were significantly associated with release (P<.01), but not transfer (P=.18). Prison-based HCV treatment achieves similar outcomes to community-based treatment, with those not released or transferred during treatment doing particularly well. Transfer or release during therapy should be avoided whenever possible, using anticipatory planning and medical holds where appropriate.

Previous incarceration impacts access to hepatitis C virus (HCV) treatment among HIV‐HCV co‐infected patients in Canada

“…Several countries including Canada, the United States and Australia have recently begun to prioritize treatment of inmates with sentences that allow for the completion of DAA therapy during incarceration . This is a reasonable approach owing to lower SVR rates among inmates who are initiated on treatment but who are subsequently transferred or released . Given the recent prioritization of HCV treatment for people in federal prisons in Canada , where sentences are greater than two years, the results of our study – that HIV‐HCV co‐infected persons with a history of incarceration experience decreased HCV treatment uptake – likely reflect both deficiencies in HCV treatment programmes in Canadian correctional facilities and a lack of linkage to HCV care at the time of release.…”

A systematic review on models of care effectiveness and barriers to Hepatitis C treatment in prison settings in the EU/EEA

“…A total of 6,107 articles were identified from the three electronic databases covering the broad project areas, of which 21 articles on HCV treatment in prison settings were included after applying the inclusion and exclusion criteria . From the grey literature, 11 conference abstracts and 2 unpublished research reports were included after applying the inclusion and exclusion criteria and check for duplicity with the peer‐reviewed literature .…”

Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

“…Annual rates of HCV treatment for incarcerated and community PWID in Scotland were estimated for 2008–2014 from their national treatment database(27–29). Community and prison SVR rates for HCV treatment with pegylated interferon and ribavirin over 2008–2014 were parameterised based on recent analyses of HCV treatment outcomes amongst Scottish patients(29), which found lower (albeit not significantly lower) SVR rates amongst incarcerated patients initiating treatment.…”

“…Community and prison SVR rates for HCV treatment with pegylated interferon and ribavirin over 2008–2014 were parameterised based on recent analyses of HCV treatment outcomes amongst Scottish patients(29), which found lower (albeit not significantly lower) SVR rates amongst incarcerated patients initiating treatment. From 2015, we assume HCV treatment with DAAs and assume only those with sufficiently long sentences are treated, with no difference in the SVR rates between prison and community.…”