Hepatitis C Virus Reinfection Following Direct-Acting Antiviral Treatment in the Prison Setting: The SToP-C Study

Abstract

Background Injection drug use (IDU) following treatment for hepatitis C virus (HCV) may lead to reinfection, particularly if access to harm reduction services is suboptimal. This study assessed HCV reinfection risk following direct-acting antiviral therapy within Australian prisons that had opioid agonist therapy (OAT) programs but did not have needle and syringe programs (NSP). Methods The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study enrolled people incarcerated in four prisons between 2014-2019. Participants treated for HCV were followed every 3-6 months to identify reinfection (confirmed by sequencing). Reinfection incidence and associated factors were evaluated. Findings Among 388 participants receiving treatment, 161 had available post-treatment follow-up and were included in analysis (92% male; median age 33 years; 67% IDU in prison; median follow-up 9 months). Among those with recent (in the past month) IDU (n=71), 90% had receptive needle/syringe sharing. During 145 person-years (PY) of follow-up, 18 cases of reinfection were identified. Reinfection incidence was 12.5/100 PY (95%CI: 7.9-19.8) overall, increasing to 28.7/100 PY; (95%CI 16.3-50.6) among those with recent IDU and needle/syringe sharing. In adjusted analysis, recent IDU with needle/syringe sharing was associated with increased reinfection risk (adjusted hazard ratio [AHR] 14.62; 95%CI 1.84-116.28; p=0.011) and longer HCV testing interval with decreased risk (i.e., chance of detection; AHR 0.41 per each month increase; 95%CI 0.26-0.64; p<0.001). Conclusion A high rate of HCV reinfection was observed within prison. Post-treatment surveillance and retreatment are essential to limit the impact of reinfection. High-coverage OAT and NSP should be considered within prisons.

Determining the frequency and characteristics of Hepatitis C reinfections in North East England

“…/100 PY). 14,17,19 We observed similar findings in the current study, with 15% of individuals treated in our 3 prisons having reinfection aftertreatmentandtheincidenceratewas14.5/100PY.Inaddition, 50% of the patients identified with reinfection had blood testing in the prison setting. This high proportion is probably due to the more comprehensive testing programme that occurs in prisons as blood borne virus testing is offered to all individuals entering the prisons in our region.…”

“…Previous studies have shown that HCV reinfection frequently occurs among individuals treated in the prison setting 14,17,19 . Rates of HCV reinfection after antiviral treatment range from 8.14 to 14.3 /100 PY in Scotish prisons and were 12.5 /100 PY in a study from 4 Australian prisons, but rates were markedly higher in individuals who reported recent injecting drug use and needle/syringe sharing (28.7 /100 PY) 14,17,19 .…”

“…18 Previous studies have shown that HCV reinfection frequently occurs among individuals treated in the prison setting. 14,17,19 Rates…”

Impact of 5 years of hepatitis C testing and treatment in the North East of England prisons

“…However, there was still a high rate of HCV‐RNA positivity (6%) at reception and a significant incidence of new HCV infection (5.1 and 3.3 per 100 person‐years for HCV‐Ab and HCV‐RNA positivity, respectively) and reinfection (10.2 per 100 person‐years) indicating a large burden of untreated HCV in the community. These findings are in keeping with previous work showing, a high frequency of reinfection following antiviral treatment in people treated in the prison setting 13,19–21 . This underscores the need for all prisons to provide good harm minimisation education to all people who inject drugs that is reinforced at the time of release.…”

Incidence of primary hepatitis C virus infection among people who inject drugs in Australia pre‐ and post‐unrestricted availability of direct acting antiviral therapies

“…Secondly, this study used HCV antibody results and incidence rates did not include re-infection. This may have resulted in an underestimation of the incidence of all new HCV infections, particularly in the post-DAA time-period, where re-infection has been demonstrated in Australia [27,28]. Similarly, incidence of primary HCV infection may have been be underestimated in the pre-DAA time-period, where receptive sharing of syringes, a significant risk factor for HCV transmission [16], was higher among respondents with a single survey record than those retained in our data set.…”