Implementation of Treating Chronic Hepatitis C in a Correcting Institute by a Hospital-Backup Clinic

Abstract

Background: chronic viral hepatitis C (HCV) is endemic in the correctional facilities due to intravenous drug use (IDU). In Taiwan, the health insurance reimbursed the interferon-based dual therapy for chronic HCV in the correcting institute since Jan 2013. Therefore, this work is to investigate the feasibility and safety of a hospital-backup clinic care to treat HCV with dual therapy in a correcting facility. Pingtung Christian Hospital established regular clinics on weekdays inside this correcting facility, and offered the computer system, physicians, clinical nurses, laboratory and pharmacy. The chronic HCV infected prisoner was cared in a regular hepatitis clinic, the consultation, blood test, serology and virology test, sonogram, interferon injection were implemented in the clinics, but EPO and transfusion was not offered. Prisoners, who had the will and fitted the indication/contra-indication of interferon-based therapy, were enrolled for treatment. The therapy was guided by Taiwan health insurance guideline---Pegasys 180 mcg/week combined ribavirin 15 mg/kg/day for 6 months if rapid viral response (RVR) achieved, and 12 months if RVR not achieved but early viral response achieved regardless of genotype. From Apr 2013 to Dec 2016, 103 voluntary prisoners, mean 39.3 ± 5.9 years old, all male and IDU, were enrolled for dual therapy. All the treatment-related events were managed inside the facility and the most common side effects of therapy is skin rash with itching in which anti-histamine medication was necessary but did not cause withdrawing. The rapid viral response rate was achieved in 70.9% of treatment inmates, 11 patients withdrew from therapy due to 4 influenza-like side effects, 1insomnia, 1 hyperthyroidism, 1 flared psoriasis, 2 early releases and 2 transferring prison. Among the 92 cases of complete treatment, 8 patients lose SVR follow-up owing to 5 transferring and 3 early releasing. SVR was achieved in 80 patients. The per-protocol and intention-to-treat SVR is 95.2% (80/84) and 82.7% (85/103) respectively. Five patients of the 7 withdrawers achieved SVR in spite of incomplete therapy due to side effect. All of the side effect could be managed in the clinic. In conclusion, this model of hospital back-up clinic to execute interferon-based therapy for chronic HCV infected inmates was feasible and it achieves excellent eradication rate. But early release and transferring prison may interfere the comprehensive treatment and post-treatment following up, the efforts to improve the coordination between correction institutes or community should be made.