Hepatitis C Virus Prevalence, Screening, and Treatment Among People Who Are Incarcerated in Canada: Leaving No One Behind in the Direct‐Acting Antiviral Era

Abstract

More than 50% of people who are incarcerated (PWAI) in Canada report a history of drug use, 1 and about 76% of people who inject drugs (PWID) in Canada have a history of incarceration, 2 resulting in higher prevalence of hepatitis C virus (HCV) among PWAI compared with the general population. 3 The Blueprint to Inform Hepatitis C Elimination Efforts in Canada, 4 published by the Canadian Network on Hepatitis C in 2019, identifies PWAI as a priority group for increased access to HCV care. Consequently, HCV screening and treatment in correctional settings are priorities to improve the health of PWID and PWAI and to achieve the World Health Organization's 2030 HCV elimination targets. Although promising HCV screening strategies and models of care in correctional settings exist across Canada, efforts to implement HCV prevention, screening, and treatment programs in correctional settings have been slow. However, Abbreviations: CSC, Correctional Service Canada; HCV, hepatitis C virus; PWAI, people who are incarcerated; PWID, people who inject drugs; STBBI, sexually transmitted and blood-borne infection.

Community‐based models of health care for women, trans and nonbinary people released from prisons: An international scoping review with implications for Canada

“…By contrast, the rate in Canada generally is 4.3 per 100,000 (Canada, 2020). Recent estimates of the prevalence of HCV among people experiencing incarceration in Canada vary from 3.5% to 33.1%, depending on the jurisdiction and method of calculation (Bartlett et al, 2021). The incidence rate of HCV in the Canadian population overall was 30.4 per 100,000 in 2019.…”

“…Despite the emphasis in the literature on the morbidity and mortality risks associated with release from prison, most of the studies in our review did not specify that participant experience of incarceration had to be recent. Given the 'revolving door' (Padfield & Maruna, 2006) (Bartlett et al, 2021). The incidence rate of HCV in the Canadian population overall was 30.4 per 100,000 in 2019.…”

The Importance of Prisons in Achieving Hepatitis C Elimination: Insights from the Australian Experience

“…The achievements of Australia’s prison hepatitis programs have, to date, demonstrated feasibility [ 49 , 53 ], cost-effectiveness [ 58 , 59 ], acceptability to people in prison and correctional and health personnel [ 54 , 60 ], and the reduction of hepatitis C prevalence [ 51 , 61 ]. The data also highlight the extremely high rates of injecting drug use among individuals that intersect with the criminal justice system, high rates of re-incarceration, and importantly low rates of engagement either before or following incarceration in traditional community models of hepatitis C care, highlighting the significant health-care gap these individuals experience and key role that prisons play in achieving the WHO elimination targets.…”

“…The provision of custodial and community health services is often siloed, and effective referral and supported linkage to care for people entering and leaving prisons is mostly inadequate [ 77 ]. To support the bridging of this gap, some commentators have called for the transfer of responsibility for correctional healthcare to local health authorities, rather than corrective services [ 61 ].…”

Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts

“…33,38,39 Prisons have instituted opt-out HCV testing at intake. [40][41][42] Another option is POC testing at mobile clinics, shelters, and street medicine providers. 32,[43][44][45] Immigrants who are unlikely to present to primary care clinics or hospitals due to associated financial costs or immigration status can be reached at community health care events or community centers.…”