Why bother with DAA treatment in the prisons?
- There are multiple reasons for developed societies to implement DAA treatment in the prison, including the high prevalence of chronic hepatitis C in the prisoner population and the dynamic nature of that population (that is frequently circulating back into the community), the similarly high incidence of new infections occurring in the prison setting, and the window of opportunity for very effective health care provision to a population often marginalised from community-based services.
Is scale-up of treatment and TasP a replacement for other harm reduction measures, such as needle syringe programs (NSP) and opioid agonist treatment (OAT)?
- No, the data from SToP-C indicates that scale-up of DAA treatment in the prisons can significantly reduce transmissions, but to achieve and sustain a major reduction in incidence both DAA treatment and integrated harm reduction measures are needed.
What are the most important elements of the implementation plan?
- All of the elements of the plan and the implementation are important. Prisons are complex environments in which to provide health services, and so each aspect - if left untouched - has the potential to undermine success. This ranges from insufficient clinic space, to unsupportive attitudes of staff, or lack of awareness amongst prisoners.
How should the plan be implemented if there are no data on the prevalence or incidence of hepatitis C infection?
- It is reasonable to look to comparable prison systems in other regions or in other countries to provide an estimate. The evaluation plan of the DAA scale-up should include establishing data collection to record testing and treatment uptake rates as well as chronic hepatitis C prevalence. If possible, it is also important to screen for new infections and reinfections to allow measurement of the TasP benefit.
How much does the scale-up program cost?
- The costs of the program and the economic benefits to both the health and corrections organisations are being evaluated and will be published and updated on this website.