Hepatitis C Screening and Treatment Program in Hungarian Prisons in the Era of Direct Acting Antiviral Agents.

Klára Werling,Gábor Horváth,Eszter Ujhelyi,Miklós Lesch,Tamás Tóth,Emese Molnár,Judit Gács,Zoltán Péterfi,Ferenc Schneider,Béla Hunyady,Krisztina Nemesi,Judit Enyedi,Anna Nemes Nagy,Zsuzsanna Fehér,Mihály Makara,Zsófia Müller

doi:10.3390/v14020308

Abstract

A hepatitis C virus (HCV) screening and treatment program was conducted in Hungarian prisons on a voluntary basis. After HCV-RNA testing and genotyping for anti-HCV positives, treatments with direct-acting antiviral agents were commenced by hepatologists who visited the institutions monthly. Patients were supervised by the prisons’ medical staff. Data were retrospectively collected from the Hungarian Hepatitis Treatment Registry, from the Health Registry of Prisons, and from participating hepatologists. Eighty-four percent of Hungarian prisons participated, meaning a total of 5779 individuals (28% of the inmate population) underwent screening. HCV-RNA positivity was confirmed in 317/5779 cases (5.49%); 261/317 (82.3%) started treatment. Ninety-nine percent of them admitted previous intravenous drug use. So far, 220 patients received full treatment and 41 patients are still on treatment. Based on the available end of treatment (EOT) + 24 weeks timepoint data, per protocol sustained virologic response rate was 96.8%. In conclusion, the Hungarian prison screening and treatment program, with the active participation of hepatologists and the prisons’ medical staff, is a well-functioning model. Through the Hungarian experience, we emphasize that the “test-and-treat” principle is feasible and effective at micro-eliminating HCV in prisons, where infection rate, as well as history of intravenous drug usage, are high.

Highlights

The treatment of chronic hepatitis caused by the hepatitis C virus (HCV) has changed significantly during the last few years thanks to the introduction of direct-acting antiviral agents (DAAs)
Screenings and DAA treatments performed in the Hungarian prisons validate the high effectiveness, success rate and safety of this approach
Patients are treated locally in the prison, which enables close cooperation between doctor and patient and ensures optimal treatment results. No such long-running, large-scale prison program has been reported from other countries

Summary

Introduction

The treatment of chronic hepatitis caused by the hepatitis C virus (HCV) has changed significantly during the last few years thanks to the introduction of direct-acting antiviral agents (DAAs). The high efficacy of these therapies could potentially help to eliminate. The main challenge for hepatologists is to identify already infected asymptomatic patients. It is estimated that currently there are around. 71 million individuals left with active infection (HCV-RNA positivity); 50–70% of this population is unaware of their condition [1,2]. In 2016, the World Health Organization (WHO) issued a new goal: to eliminate viral hepatitis by 2030, defined as a 90% decrease in new infections and a 65% decrease in mortality [2,3,4,5].

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