Continuum of Hepatitis C Care Cascade in Prison and Following Release in the Direct-acting Antivirals Era

Abstract

Background People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison. Methods Between 2017–2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent direct-acting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12). Results Overall, from 3,485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR = 100%). Conclusions Integrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of adherence to treatment. Future studies should investigate the predictors of engagement with HCV care following release.

The effect of direct-acting antiviral regimens and telemedicine on the treatment of inmates with hepatitis C virus infection in Israeli prisons

“…The high success rate of 98.8% found in our study correlates well with previously reported results. 5,7,26–28…”

“…The high success rate of 98.8% found in our study correlates well with previously reported results. 5,7,[26][27][28] Several factors have been reported to be associated with achieving higher SVR rates in prisoners. In the era of interferon-based therapy, these included younger age, better pretreatment liver fibrosis status, HCV genotype other than 1, and lower baseline viral load.…”

“…2 More than 10.35 million people are incarcerated in jails and prisons throughout the world. 3 The prevalence of HCV infection among prisoners varies around the world: 2.8% in Geneva post-trial prisons, 4 3.4% among Iranian prisoners, 5 11.5% in Swedish prisoners in Stockholm County, 6 and 23.1% in Taiwan. 7 In the United States, the rate varies by location: 10.1% at two prison facilities in New York State, 8 and 34.3% at California State correctional facilities.…”