Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era

Sanam Hariri,Hossein Poustchi,Reza Malekzadeh,Heidar Sharafi,Shahin Merat,Fatemeh Azimian,Mohammad Mehdi Gouya,Behzad Abbasi,Mahdi Sheikh,Babak Tamadoni,Rashid Ramazani,Mehrzad Tashakorian,Seyed Moayed Alavian,Ramin Alasvand,Farnaz Hashemi

doi:10.1186/s12954-020-00431-x

Abstract

BackgroundPeople with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison.MethodsBetween 2017–2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent direct-acting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12).ResultsOverall, from 3485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison, and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR12 = 100%).ConclusionsIntegrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of treatment adherence. Future studies should investigate the predictors of engagement with HCV care following release.

Highlights

People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; the continuum of care is a major barrier to prison-based programs
Following the introduction of highly effective antiviral agents, the hepatitis C virus (HCV) infection has become curable in the recent decade [1]; treatment of infected people has been introduced as a key strategy for disease prevention in communities [2]
Overall, 3485 newly admitted male inmates participated in the study, from whom 5.2% (n = 182) tested positive for HCV antibody

Summary

Introduction

People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; the continuum of care is a major barrier to prison-based programs. Despite the encouragement brought by recent successes, many countries have challenges expanding HCV care among people with criminal justice involvement, and access to health services often ends with patient’s release back into community [9, 10]. The transition period is accompanied by many competing priorities that often prevent patients from ongoing engagement with care [9, 11] Such priorities include inadequate social and financial support, which often result in a return to drugrelated activities and may erode all health benefits gained during incarceration [9, 14, 15]

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