Hepatitis C in European prisons: a call for an evidence-informed response

Arain, Amber; Robaeys, Geert; Stöver, Heino

doi:10.1186/1471-2334-14-s6-s17

Cited by 34 publications

(35 citation statements)

References 57 publications

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“…A number of ethical issues regarding HCV testing and treatment in prison have been raised(60, 61, 67). There is a need to ensure HCV testing in prison is truly voluntary, due to potential unequal power relationships between prisoners and staff.…”

Section: Potential Impact Of Hcv Treatment As Prevention Among Pwidmentioning

confidence: 99%

“…There is a need to ensure HCV testing in prison is truly voluntary, due to potential unequal power relationships between prisoners and staff. Furthermore, as in the community, HCV treatment should be offered alongside other harm reduction interventions (such as OST) to reduce the risk of infection/reinfection(67). …”

Section: Potential Impact Of Hcv Treatment As Prevention Among Pwidmentioning

confidence: 99%

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The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM)

Martin

Vickerman

Dore

et al. 2015

Current Opinion in HIV and AIDS

124

110

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Purpose of Review The burden of HCV is high among people who inject drugs (PWID) and prisoners, and increasing among HIV-infected men who have sex with men (MSM), who are key populations for HCV transmission in high-income countries, and may also play a role in many in low and middle-income countries. There is increasing interest in the use of HCV antiviral treatment for prevention in these populations. Recent Findings Numerous theoretical modeling studies have explored the potential impact of HCV treatment for prevention among PWID in a range of global settings, generally finding that modest and achievable levels of HCV treatment, especially with interferon-free direct acting antiviral therapy (IFN-free DAAs), could substantially reduce HCV chronic prevalence among PWID within the next 10–20 years. Additionally, modelling studies have shown HCV testing and treatment in prison (including prevention benefits) could be cost-effective if continuity of care is ensured, or HCV treatments are shortened with DAAs. Modelling work among HIV-infected MSM has shown that further HCV treatment scale-up is likely required despite high treatment rates in this population. However, no empirical studies have explored whether HCV treatment can reduce HCV prevalence and prevent onwards transmission among those at risk of transmission. Summary HCV treatment for key populations such as PWID, prisoners, and MSM could become an important HCV prevention intervention, especially in the IFN-free DAA era. However, there is an urgent need to test these hypotheses through empirical studies.

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Section: Potential Impact Of Hcv Treatment As Prevention Among Pwidmentioning

confidence: 99%

Section: Potential Impact Of Hcv Treatment As Prevention Among Pwidmentioning

confidence: 99%

The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM)

Martin

Vickerman

Dore

et al. 2015

Current Opinion in HIV and AIDS

124

110

View full text Add to dashboard Cite

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“…Prison could be an important setting to deliver HCV prevention interventions, although few countries currently do this(4, 11, 12). In Spanish prisons, PWID experience five-fold lower incidence if on OST(13).…”

Section: Introductionmentioning

confidence: 99%

“…HCV treatment for incarcerated PWID, especially with shorter direct-acting antivirals (DAAs(16)), could reduce HCV transmission in prison and the community. However, although modelling suggests testing and treatment with DAAs could be cost-effective in UK prisons(17), HCV treatment in prison remains low(11). …”

Section: Introductionmentioning

confidence: 99%

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

Martin²,

et al. 2017

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Background and AimsPeople who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. In Scotland, national survey data indicate lower HCV incidence in prison than the community (4.3 versus 7.3 per 100 person‐years), but a 2.3‐fold elevated transmission risk among recently released (< 6 months) PWID. We evaluated the contribution of incarceration to HCV transmission among PWID and the impact of prison‐related prevention interventions, including scaling‐up direct‐acting antivirals (DAAs) in prison.DesignDynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.SettingScotland, UK.ParticipantsA simulated population of PWID.MeasurementsPopulation‐attributable fraction (PAF) of incarceration to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment, as well as scaling‐up DAAs in prison and/or preventing the elevated risk associated with prison release.FindingsIncarceration contributes 27.7% [PAF; 95% credible interval (CrI) –3.1 to 51.1%] of HCV transmission among PWID in Scotland. During the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95% CrI = 8.4–13.3%) and 9.7% (95% CrI = 7.7–12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95% CrI = –28.5 to 18.0%) and 4.7% (95% CrI = –11.3 to 14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95% CrI = 19.7–57.5%) and 33.3% (95% CrI = 15.6–43.6%) or scaling‐up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95% CrI = 38.0–51.3%) and 45.5% (95% CrI = 39.3–51.0%), respectively.ConclusionsIncarceration and the elevated transmission risk following prison release can contribute significantly to hepatitis C virus transmission among people who inject drugs. Scaling‐up hepatitis C virus treatment in prison can provide important prevention benefits.

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“…58 These medications, however, are very expensive, and treatment for chronic HCV has remained underused in prisons. 58,59 In countries where HCV treatment is available to prisoners, treatment remains restricted to individuals who are classified as high-priority candidates for treatment, such as those with cirrhosis. 60 This clinical practice—which withholds effective treatment from most incarcerated individuals with chronic HCV infection—could be characterised as a human rights violation.…”

Section: Viral Hepatitis In Prisonsmentioning

confidence: 99%

Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis

et al. 2016

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The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the provision of medical care in the prison and jail settings of low-income and middle-income countries compared with high-income countries. Structural barriers impede the optimal delivery of clinical care for prisoners, and substance use, mental illness, and infectious disease further complicate the delivery of care. For prison health care to reach the standards of community-based health care, political will and financial investment are required from governmental, medical, and humanitarian organisations worldwide. In this review, we highlight challenges, gaps in knowledge, and priorities for future research to improve health-care in institutions for prisoners.

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Hepatitis C in European prisons: a call for an evidence-informed response

Cited by 34 publications

References 57 publications

The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM)

The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM)

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

Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis

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