Abstract

BackgroundHepatitis C Virus (HCV) infection is endemic in prison populations, and HCV management in prisons is suboptimal. Incarceration is a public health opportunity to target this cohort. Community peer support increases HCV screening and treatment uptake. Prison peer workers have the potential to support the engagement of prisoners with health services and reduce stigma. This study’s primary aim is to evaluate peer-supported screening as a model of active HCV case finding with a secondary aim to describe the HCV cascade among those infected including linkage to care and treatment outcomes.MethodsAn observational study was conducted in a medium-security Irish male prison housing 538 inmates, using a risk-based questionnaire, medical records, peer-supported screening, laboratory-based HCV serology tests and mobile elastography.ResultsA prison peer-supported screening initiative engaged large numbers of prisoners in HCV screening (n = 419). The mean age of participants was 32.8 years, 92% were Irish and 33% had a history of injecting drug use. Multiple risk factors for HCV acquisition were identified including needle sharing (16%). On serological testing, 87 (21%) were HCV Ab +ve and 50 (12%) were HCV RNA +ve of whom 80% were fibroscaned (25% showing evidence of liver disease). Eighty-six percent of those with active infection were linked with HCV care, with 33% undergoing or completing treatment. There was a high concordance with HCV disclosure at committal and serological testing (96% for HCV Ab +ve and 89% for HCV Ab −ve).ConclusionPeer-supported screening is an effective active HCV case-finding model to find and link prisoners with untreated active HCV infection to HCV care.

Highlights

  • Hepatitis C Virus (HCV) infection is endemic in prison populations, and HCV management in prisons is suboptimal

  • This study reports on the feasibility and impact of a peer-supported HCV screening and linkage-to-care intervention to increase the numbers of HCV infections detected—in particular new infections, linkage to care, treatment engagement and treatment outcomes in the Irish Prison Service (IPS)

  • Of those who answered the questions on drug use in the risk questionnaire, 45% had a history of heroin use and 33% a history of injecting drug use (IDU)

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Summary

Introduction

Hepatitis C Virus (HCV) infection is endemic in prison populations, and HCV management in prisons is suboptimal. Community peer support increases HCV screening and treatment uptake. This study’s primary aim is to evaluate peer-supported screening as a model of active HCV case finding with a secondary aim to describe the HCV cascade among those infected including linkage to care and treatment outcomes. Untreated hepatitis C viral (HCV) infection poses a major public health problem and is endemic in prison populations globally [1, 2]. A number of successful strategies have been shown to increase HCV screening uptake in prisoners. These include the introduction of opt-out rather than an opt-in policy for screening, the use of point of care testing (POC). The uptake of risk-based screening is dependent on prisoners admitting to a history of IDU with its associated stigma, a recognised barrier to both HCV screening and treatment [24]

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