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

Abstract

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.

Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action

“…In the other 13 countries, the extent of HCV treatment was reported as available in more than half of all prisons, less than half of all prisons or unknown. Another study estimated the prison population in need of treatment in France, Germany, Italy, Spain and United Kingdom (England and Wales) to be between 6000 and 9000 in 2015 [ 39 ], representing 9.3 to 11.5% of the total prisons population in these countries highlighting a large treatment gap. More recent information from the EMCDDA indicate that HCV treatment in prisons is now available in 24 European countries, but data on coverage are lacking [ 28 ].…”

Cost-effectiveness analysis of chronic hepatitis C treatment in the prison population in Spain

“…El tratamiento con los actuales AAD para la HCc ha demostrado generar beneficios a nivel epidemiológico, clínico y económico 19,20 . Por consiguiente, la principal herramienta para eliminar la infección por VHC debería ser dar acceso a terapias con AAD sin limitaciones, aunque esta herramienta pueda y deba complementarse con otras de tipo preventivo y educativo, como ha sido recomendado por expertos del ámbito penitenciario en alguna reciente publicación 31 . Sin embargo, este acceso está restringido en muchos países 32 , y todavía más en presos 33 , básicamente por motivos económicos 34,35 .…”

“…Treatment with current DAAs for CHC has demonstrated that they generate benefits at epidemiological, clinical and economic levels 19 - 20 . Therefore, the main strategy for eliminating HCV infection recommended by prison experts in a recent publication 31 . However, access to this treatment is access to this is restricted in many countries 32 and even more so to even more in prisoners 33 , essentially for economic reasons 34 - 35 .…”

The State of Harm Reduction in Prisons in 30 European Countries with a Focus on People Who Inject Drugs and Infectious Diseases

“…Studies on evidence of effectiveness of these measures inside prison are limited (10,52,53). However, doubts are raised on the need to have evidence of effectiveness for implementing health interventions inside prison when those interventions have been already proved to be effective in the community (53)(54)(55)(56)(57). Furthermore equivalence and continuity of care are key principles for conducting health and social interventions in prisons (53,(58)(59)(60) and intervening on people in prison may have a larger positive impact on public health in the community (53,61,62).…”