Hepatitis C treatment and prevention in prisons

Prevention of hepatitis C transmission in the prisons

The key strategies for prevention of hepatitis C transmission amongst people who inject drugs (PWID) in the wider community, include opiate agonist therapy (OAT) and needle-syringe programs (NSP). These prevention approaches can approximately halve the rate of new infections in the community.

Injecting drug use in prison has been associated with a high probability of sharing, as injecting equipment is sparse and often heavily re-used. There are very few prison-based NSPs worldwide (none in Australia), thereby driving repeated use of injecting equipment.

In addition, OAT, which is only variably available in prison settings, has not been shown to reduce transmissions within correctional centres.

“Can we treat our way out of this epidemic in the prison setting? Whether it’s successful or sub-optimal in its efficacy, I would still maintain that provision of clean injecting equipment makes public health sense.”


Testing and treatment of hepatitis C infection in prisons

With the growing availability of direct acting antivirals (DAAs) to cure hepatitis C, testing and treatment services are increasingly being developed outside specialist hospital clinics, in favour of primary care settings where the majority of those infected are found, including in prisons.

The pathway for hepatitis C care is often referred to as the care cascade, and includes the following steps:

Hepatitis C care cascade

1. Education of the at-risk population to get tested.
2. Screening for hepatitis C antibodies and viral RNA.
3. Clinical and laboratory assessments of those with chronic hepatitis C.
4. Prescription and provision of DAA medication.
5. Monitoring after treatment completion for cure (or sustained virological response, SVR).
6. Monitoring after cure for reinfection in those with ongoing risk behaviour.
7. Retreatment of those who become reinfected.

Provision of each of the elements of this hepatitis care cascade in the prison sector varies widely, ranging from no screening to universal testing of all prisoners, and from no treatment to individual correctional centres offering ready provision of DAA treatment, as well as screening for reinfection and retreatment.