Prisons and HCV: a review and a report on an experience in New South Wales Australia

Abstract

Prison populations in Western countries are characterised by a high hepatitis C prevalence. This reflects a high rate of imprisonment for drug related offences. Prison entrants who are HCV-negative face a significant risk of acquiring hepatitis C. Effective prevention strategies and successful treatment of a significant percentage of hepatitis C-positive inmates could reduce the risk of transmission in the prison context significantly. Several reports of treating hepatitis C in prisoners in major facilities have been published. We report our experience of establishing a liver clinic service in two regional prisons in New South Wales, Australia. Liver biopsy requirements to access treatment in Australia meant that only 46 of 196 reviewed patients were able to commence treatment in our 5-year experience. Treatment completion rate was 61% and end of treatment viral response was 57%. The removal of liver biopsy requirements in Australia in April 2006 has freed up access to treatment and our results encourage further effort to optimise the process of assessment and treatment in this high-risk population.

Establishment of a successful assessment and treatment service for Australian prison inmates with chronic hepatitis C

“…The service provided effective assessment and treatment of chronic hepatitis C for several population groups who are typically hard to reach in the community setting, including Indigenous Australians, IDUs and those with significant psychiatric comorbidities. Our findings add to a growing body of literature which confirms that chronic HCV may be successfully treated in prison, 14 , 15 , 19 including a preliminary report from one centre of the statewide service 20 …”

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

“…HCV is endemic in prison populations globally [96], with recorded prevalence among inmates as high as 57/58% (Australia, Greece) [98]. HCV treatment availability in prisons is uneven [90,96], with barriers to treatment access including: limited access to diagnostic tests, biopsy requirements and delays; abstinence eligibility requirements; prohibitive costs to delivery; and lack of infrastructure and funding [90].…”

“…HCV treatment availability in prisons is uneven [90,96], with barriers to treatment access including: limited access to diagnostic tests, biopsy requirements and delays; abstinence eligibility requirements; prohibitive costs to delivery; and lack of infrastructure and funding [90]. In countries where HCV treatment is available in prisons, such as the UK, USA, Canada, France and Australia, there can be additional difficulties with: taking medications into prison; obtaining consistent clinical monitoring, medical support and follow-up; biopsy requirements; treatment interruptions due to prison transfers, intake and release; lack of aftercare; and limited understanding of HCV treatment by prison staff [40,77,96-99]. There are, however, documented examples of successful HCV treatment provision in prisons, resulting in rates of viral response comparable to treatment in the community [96,98,100].…”

High prevalence of late relapse and reinfection in prisoners treated for chronic hepatitis C

“…Treatment outcomes of chronic HCV infection in incarcerated patients have been reported following both standard and pegylated interferon (IFN) therapy 5–9 . These studies have shown that the rates of treatment completion and sustained virological response (SVR) in prisoners is comparable to that of the general population, but lower rates have also been found 10,11 .…”