Hepatitis C Micro-Elimination beyond Prison Walls: Navigator-Assisted Test-and-Treat Strategy for Subjects Serving Non-Custodial Sentences

Abstract

Background and Aims: The Spanish prison population includes two groups: people in prison and those who are serving non-custodial sentences. The latter has not yet been studied. This study aims to describe this population and the results of a test-and-treat strategy for hepatitis C including a holistic health assessment. Method: This prospective study included all subjects serving non-custodial sentences at the Center for Social Integration. It was assisted by the medical team, a navigator, and a systematic screening of HCV (Hepatitis C Virus) performed by point-of-care tests. All cases with active infection are evaluated using telemedicine by a specialist to prescribe antiviral treatment. The navigator facilitates continuity for medical and social assistance. Results: The screening rate reached 92.8% (548/590). HCV seroprevalence and viraemia prevalence were 8% (44) and 2.9% (16), respectively. Regarding comorbidities: problems related to drug dependence were detected in 264 (48.2%), suspected serious mental disorder in 44 (8.3%), and previous stay in prison in 122 cases (22.2%). The navigator monitored 59 (15.2%) patients regarding HCV treatment or comorbidities. All patients (10/10) completing 12 weeks follow-up achieved sustained virological response. Conclusions: The population serving non-custodial sentences is a challenging group with a high prevalence of HCV infection. Micro-elimination programs using point of care diagnostic tests, telemedicine, and a navigator are necessary in this underserved vulnerable population.

Real-life experience of hepatitis C treatment in a Spanish prison

“…Spain started a pilot program to detect and treat HCV in prisons in 2016. The results of this study showed that a sustained viral response was achieved in greater than 95% of treated patients [ 7 ], and this result is consistent with our data. Toxicity and therapeutic abandonment were exceptional [ 20 ].…”

A Global Systematic Review of Hepatitis C Elimination Efforts through Micro-Elimination

“…16 However, in Spain, one model of care to screen and treat all HCV-RNA positive patients through telemedicine has shown promising HCV elimination results, with cure rates of 97%, 17 and another which targeted those serving noncustodial sentences in Spain had good success with a novel microelimination approach. 18 In addition, using telemedicine to engage incarcerated persons has been reported as cost saving. 19 In the United Kingdom, a recent study has reported promising testing and treatment uptake among incarcerated persons using a rapid screening and treatment model.…”

People in community corrections are a population with unmet need for viral hepatitis care

“…We searched PubMed and OVID Medline for studies published in English language using the search terms hepatitis C OR viral hepatitis AND probation OR parole OR community correction∗ and found four studies which evaluated viral hepatitis testing in community corrections and linkage to onsite (n = 1) or external (n = 3) assessment and treatment services ( Table 1 ). Onsite assessment and treatment was evaluated by Cabezas and colleagues 24 who reported that among 548 people who received point-of-care finger-prick testing at a single community corrections site in Spain, 16 (3%) were hepatitis C RNA positive, of whom 13 (81%) commenced treatment. In Pawtucket, Rhode Island, Jacka et al.…”