Improving detection and management of HCV infection in prisons

Ekeke, Nnenna; Francis-Graham, Seth; King, Tracey L.; Demma, Shirin; Rosenberg, William

doi:10.1016/s0168-8278(18)30832-8

Cited by 3 publications

(2 citation statements)

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“…Relevant examples of effective policy and practice choices include the offering of voluntary HCV screening on entry and after 6 months continuously until release if the result is negative for prisoners and pre-trial detainees [ 40 ]. Opt-out HCV screening (rather than opt-in) is effective [ 42 , 43 ] and use of simple tools such as dried blood spot testing kits is optimal [ 35 , 44 , 45 ]. Best policy and practice also includes clear referral pathways to access treatment delivered by integrated multidisciplinary care teams [ 35 , 45 – 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…Opt-out HCV screening (rather than opt-in) is effective [ 42 , 43 ] and use of simple tools such as dried blood spot testing kits is optimal [ 35 , 44 , 45 ]. Best policy and practice also includes clear referral pathways to access treatment delivered by integrated multidisciplinary care teams [ 35 , 45 – 47 ]. Set up of services for each prison including a realistic, non-limiting, working relationship with a specialist expert in infectious diseases is advised [ 46 , 48 ]; achieving continuity of care on release is also an important part of policy and guidance for services [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

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Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe

Stöver

Meroueh²,

Marco³

et al. 2019

BMC Public Health

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BackgroundPrisoners have a high prevalence of hepatitis C virus (HCV) infection but may find it difficult to access healthcare services. This may be related to risk behaviour including history of injecting drugs and marginalisation related to problem drug use/ opioid use disorder (OUD). Direct-acting antiviral products with superior efficacy and safety compared to interferon-based regimens offer HCV cure. Many citizens in Europe have been treated, although few received therapy in prisons.MethodsAnalysis of prisoner HCV treatment need and policy determinants of clinical practice was completed for 5 EU countries. Evidence was collected from national statistical sources and peer-reviewed publications to describe prison populations and HCV prevalence, to map national prison/ HCV health policy or guidance. A consensus of important principles for prisoner HCV care was developed.ResultsData from published sources describing prisoner HCV prevalence is limited. Prisoner population requiring HCV treatment is not known; estimated numbers based on analysis of evidence: England and Wales, 9000, France, 8000, Spain, 6000, Italy, 6000, Germany, 6000. Treatment access: national law defines right to equivalent care in all countries implying access to HCV therapy in prison similar to community; useful prisoner HCV guidance facilitating treatment decisions present in: 4 of 5 national/ regional HCV policy documents, 4 of 5 national prison healthcare policies. Four of five had practical prison HCV clinical guidelines. Despite existence of policy, implementation of guidance, and so HCV treatment, is suboptimal in many locations.ConclusionsPrison is an important location to detect, address and treat HCV infection in people who may be underserved for healthcare and find it difficult to navigate community treatment pathways. This is often related to problems with OUD and resulting social inequity. HCV management in prisons must be improved. Policy and clinical practice guidance must be set to promote treatment, and practical steps to make treatment easy should be followed including education to promote engagement, set-up of optimal screening and work up processes with modern tools to reduce time needed/ achieve efficiency; programs to make it easier to get specialists’ input include remote working and nurse-led services.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe

Stöver

Meroueh²,

Marco³

et al. 2019

BMC Public Health

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Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update

et al. 2019

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Background Although significant improvement in efficacy measured by a sustained virological response, the high acquisition costs of direct-acting antivirals limit the access for patients and influence the costs of healthcare resource utilisation in hepatitis C. It is important to have the latest estimates of prevalence, especially in high-risk groups, for cost of illness, cost-effectiveness and budget impact studies. Methods Original studies on the estimates of the prevalence among general and high-risk groups in the European Union/European Economic Area (EU/EEA) were retrieved from Medline and Embase for the period from 2015 to 2018. All included studies were evaluated for risk of selection bias and summarised together in a narrative form. Results from previous reviews and updated searches were compared per country among different populations, respectively. Results Among the 3871 studies identified, 46 studies were included: 20 studies were used for the estimate of the general population; 3 for men who have sex with men (MSM); 6 for prisoners; and 17 for people who inject drugs (PWID). Compared with the results reported in previous systematic reviews, the updated estimates were lower than previously in most available countries. Anti-HCV general population prevalence estimates ranged from 0.54 to 1.50% by country. The highest prevalence of anti-HCV was found among PWID (range of 7.90–82.00%), followed by prisoners (7.00–41.00%), HIV-positive MSM (1.80–7.10%), HIV-negative MSM (0.20–1.80%), pregnant women (0.10–1.32%) and first-time blood donors (0.03–0.09%). Conclusions Our study highlights the heterogeneity in anti-HCV prevalence across different population groups in EU/EEA. The prevalence also varies widely between European countries. There are many countries that are not represented in our results, highlighting the need for the development of robust epidemiological studies. Electronic supplementary material The online version of this article (10.1186/s12879-019-4284-9) contains supplementary material, which is available to authorized users.

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An opt-out approach to hepatitis C virus testing in English prisons: the literature underpinning the policy

Jack

2021

Br J Nurs

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Background: The World Health Organization's aim to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030 is dependent on testing people. HCV prevalence is higher in prisons, so to increase test uptake an ‘opt-out’ approach to blood-borne virus testing in English and Welsh prisons was introduced. Aims: This literature review examines the evidence behind the introduction of this public health policy. Methods: Four healthcare databases were searched for publications between January 2000 and February 2020 on the opt-out approach to blood-borne virus testing in prisons. Findings: Sixteen studies published between 2009 and 2019 were included. Analysis of their findings showed that an increase in HCV test uptake in prisons occurs when an opt-out approach is used in combination with additional interventions. Contextual differences between UK and US prisons may affect HCV test uptake. Conclusion: An opt-out approach to HCV testing in prisons can increase test uptake as part of a complex of interventions.

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Improving detection and management of HCV infection in prisons

Cited by 3 publications

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Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe

Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe

Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update

An opt-out approach to hepatitis C virus testing in English prisons: the literature underpinning the policy

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