HCV elimination: breaking down the barriers to prison based care

Abstract

Hepatitis C virus (HCV) remains a major public health threat worldwide, responsible for 500,000 deaths annually; hepatocellular carcinoma (HCC) remains one of the major causes of HCV-related mortality. The global prevalence of HCV is approximately 1.0%, and in developed countries, injecting drug use continues to be the primary risk factor in incident cases. Targeted treatment of people who inject drugs (PWID) is important for achieving the WHO goals of eliminating viral hepatitis, which will have a significant impact on reducing HCC rates. Due to the close relationship between injecting drug use, incarceration and chronic HCV, the prevalence of HCV is up to 40 times greater within correctional facilities compared with the community. However, very few prisoners are treated for HCV while incarcerated. This is a result of financial, logistical and prisoner barriers to HCV care within correctional facilities. In the era of direct acting antiviral (DAA) therapy which is highly efficacious, time-efficient and safe, modelling studies have identified the benefit of increasing HCV treatment uptake amongst PWIDs to reduce community prevalence via treatment-as-prevention. Despite this, there are few real-world data evaluating DAA therapy within prison settings. In this article, we review the barriers to HCV care within prison systems, the outcomes of traditional HCV treatment programs within prisons and emerging data regarding the benefit of DAA therapy within correctional facilities. We present the mathematical modelling regarding the impact of treatment as prevention amongst PWIDs to eliminate HCV as a public health threat and how the prison fits into this paradigm.

Keywords

Hepatitis C virus / people who inject drugs / prisoner / elimination / direct acting antiviral

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