Purpose: The Prevalhep study seeks to determine the prevalence of factors associated with hepatitis C virus (HCV) and B (HBV) in Spanish prisoners Methods: Observational, cross-sectional study which randomly selected 18 Spanish prisons to participate, and with 21 prisoners/CentreResults: There were 378 prisoners selected, 370 of whom had serological HCV and 342 had VHB data. The HCV population were predominantly male (91.6%), of middle age (66.7% contact status with HBV (HBcAb+ and/or HBsAg+), while 37.5% were susceptible to HB. Conclusions:The prevalence of HBV and HCV has decreased in the Spanish prison population, probably as a result of decrease in IDU transmission, and an increase in immigrant prisoner population that does not have this risk behaviour.[Word count = 198]

BackgroundPrisoners have a high prevalence of hepatitis C virus (HCV) infection but may find it difficult to access healthcare services. This may be related to risk behaviour including history of injecting drugs and marginalisation related to problem drug use/ opioid use disorder (OUD). Direct-acting antiviral products with superior efficacy and safety compared to interferon-based regimens offer HCV cure. Many citizens in Europe have been treated, although few received therapy in prisons.MethodsAnalysis of prisoner HCV treatment need and policy determinants of clinical practice was completed for 5 EU countries. Evidence was collected from national statistical sources and peer-reviewed publications to describe prison populations and HCV prevalence, to map national prison/ HCV health policy or guidance. A consensus of important principles for prisoner HCV care was developed.ResultsData from published sources describing prisoner HCV prevalence is limited. Prisoner population requiring HCV treatment is not known; estimated numbers based on analysis of evidence: England and Wales, 9000, France, 8000, Spain, 6000, Italy, 6000, Germany, 6000. Treatment access: national law defines right to equivalent care in all countries implying access to HCV therapy in prison similar to community; useful prisoner HCV guidance facilitating treatment decisions present in: 4 of 5 national/ regional HCV policy documents, 4 of 5 national prison healthcare policies. Four of five had practical prison HCV clinical guidelines. Despite existence of policy, implementation of guidance, and so HCV treatment, is suboptimal in many locations.ConclusionsPrison is an important location to detect, address and treat HCV infection in people who may be underserved for healthcare and find it difficult to navigate community treatment pathways. This is often related to problems with OUD and resulting social inequity. HCV management in prisons must be improved. Policy and clinical practice guidance must be set to promote treatment, and practical steps to make treatment easy should be followed including education to promote engagement, set-up of optimal screening and work up processes with modern tools to reduce time needed/ achieve efficiency; programs to make it easier to get specialists’ input include remote working and nurse-led services.

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Treatment discontinuation for chronic hepatitis C in the penitentiary setting is low. However, further efforts should be made to improve the coordination between penitentiary institutions and external centers to ensure treatment after the inmates are released or transferred to other prisons.

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