Promoting HCV Treatment Completion for Prison Inmates: New York State's Hepatitis C Continuity Program

Klein, Susan; Wright, Lester N.; Birkhead, Guthrie S.; Mojica, Benjamin A.; Klopf, Linda C.; Klein, Laurence A.; Tanner, Ellen; Feldman, Ira S.; Fraley, Edward J.

doi:10.1177/00333549071220s216

Cited by 26 publications

(20 citation statements)

References 26 publications

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“…In supporting the establishment of HCV clinics in a number of NSW prisons, Justice Health in New South Wales has offered prisoners the opportunity to receive timely advice about HCV and other BBVs, testing for the infections and for some, appropriate treatment of their infection. Our clinical experience adds to a growing literature which confirms that this disease can be treated in prison settings (Allen et al, 2003;Farley et al, 2005a,b,c;McGovern et al, 2006;Remy, 2006;Klein et al, 2007). Only 48 of 196 (24.5%) new cases of HCV commenced on treatment in the period reviewed, a lower rate than reported in liver clinic experience (Smart et al, 2003).…”

Section: Discussionsupporting

confidence: 54%

Prisons and HCV: a review and a report on an experience in New South Wales Australia

Batey

Jones

McAllister

2008

International Journal of Prisoner Health

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Prison populations in Western countries are characterised by a high hepatitis C prevalence. This reflects a high rate of imprisonment for drug related offences. Prison entrants who are HCV-negative face a significant risk of acquiring hepatitis C. Effective prevention strategies and successful treatment of a significant percentage of hepatitis C-positive inmates could reduce the risk of transmission in the prison context significantly. Several reports of treating hepatitis C in prisoners in major facilities have been published. We report our experience of establishing a liver clinic service in two regional prisons in New South Wales, Australia. Liver biopsy requirements to access treatment in Australia meant that only 46 of 196 reviewed patients were able to commence treatment in our 5-year experience. Treatment completion rate was 61% and end of treatment viral response was 57%. The removal of liver biopsy requirements in Australia in April 2006 has freed up access to treatment and our results encourage further effort to optimise the process of assessment and treatment in this high-risk population.

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Section: Discussionsupporting

confidence: 54%

Prisons and HCV: a review and a report on an experience in New South Wales Australia

Batey

Jones

McAllister

2008

International Journal of Prisoner Health

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“…However, the cost-effectiveness of prison case-finding interventions depends on adequate continuity of care with the community. Few settings have developed comprehensive strategies to address this issue, though New York recently initiated the Hepatitis C Continuity Program 48. In all settings, treatment uptake is critical: higher treatment rates prevent more disease transmission and increase the cost-effectiveness of case-finding interventions.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons

et al. 2013

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ObjectivesPeople who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV), but many are unaware of their infection. HCV dried blood spot (DBS) testing increases case-finding in addiction services and prisons. We determine the cost-effectiveness of increasing HCV case-finding among PWID by offering DBS testing in specialist addiction services or prisons as compared to using venepuncture.DesignCost-utility analysis using a dynamic HCV transmission model among PWID, including: disease progression, diagnosis, treatment, injecting status, incarceration and addition services contact.SettingUK.InterventionDBS testing in specialist addiction services or prisons. Intervention impact was determined by a meta-analysis of primary data.Primary and secondary outcome measuresCosts (in UK £, £1=US$1.60) and utilities (quality-adjusted life years, QALYs) were attached to each state and the incremental cost effectiveness ratio (ICER) determined. Multivariate uncertainty and one-way sensitivity analyses were performed.ResultsFor a £20 000 per QALY gained willingness-to-pay threshold, DBS testing in addiction services is cost-effective (ICER of £14 600 per QALY gained). Under the base-case assumption of no continuity of treatment/care when exiting/entering prison, DBS testing in prisons is not cost-effective (ICER of £59 400 per QALY gained). Results are robust to changes in HCV prevalence; increasing PWID treatment rates to those for ex-PWID considerably reduces ICER (£4500 and £30 000 per QALY gained for addiction services and prison, respectively). If continuity of care is >40%, the prison DBS ICER falls below £20 000 per QALY gained.ConclusionsDespite low PWID treatment rates, increasing case-finding can be cost-effective in specialist addiction services, and in prisons if continuity of treatment/care is ensured.

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“…The rationale in both cases was to ensure that treatment could be completed, because medications and health insurance are seldom available to those who leave prison. Other states, such as New York, do not have such restrictions [65]. Expanding access to treatment for many other patients, however, hinges on the creation of effective transitional programs that would link patients to community-based care after release [66].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Hepatitis C Treatment in a Prison Setting: Feasibility and Effectiveness for Challenging Treatment Populations

et al. 2008

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Background More than one-third of people in the United States with hepatic C virus (HCV) infection pass through the correctional system annually. Data are lacking on outcomes of treatment with pegylated interferon plus ribavirin (PEG-RBV) in correctional settings. Methods During 2002–2006, we analyzed patients in the Connecticut Department of Correction who received PEG-RBV. We assessed the rates of sustained virological response, hospitalization, and use of medications to treat psychiatric disorders and anemia. Results Of 138 treatment-naive patients referred for treatment, 68 (49%) were approved. Overall, sustained virological response occurred in 47.1% of patients (for HCV genotype 1, 43.1%; for HCV genotypes 2 and 3, 58.8%). Only 9 patients (13%) discontinued treatment because of adverse effects. Multiple regression analysis revealed that not achieving a sustained virological response was correlated with HCV genotype 1 infection plus cirrhosis (adjusted odds ratio, 12.9; 95% confidence interval, 1.1–148) and baseline major depression (adjusted odds ratio, 3.4; 95% confidence interval, 1.01–11.6), but not with HIV infection, a baseline HCV RNA level ⩾400,000 IU/mL, or black race. Compared with baseline, the rate of prescription of a new mood stabilizer (2.2 vs. 0.8 prescriptions per person-year) or an opioid (1.8 vs. 0.5 prescriptions per person-year) was higher during treatment, whereas there was no change in the rate of prescription of benzodiazepines and antipsychotic medications. Conclusions These results support the feasibility and clinical effectiveness of PEG-RBV for the treatment of chronic HCV infection in correctional facilities.

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Promoting HCV Treatment Completion for Prison Inmates: New York State's Hepatitis C Continuity Program

Cited by 26 publications

References 26 publications

Prisons and HCV: a review and a report on an experience in New South Wales Australia

Prisons and HCV: a review and a report on an experience in New South Wales Australia

Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons

Clinical Outcomes of Hepatitis C Treatment in a Prison Setting: Feasibility and Effectiveness for Challenging Treatment Populations

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