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Unrestricted access to DAAs nearly eliminates HCV in Australian prison

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March 19, 2018

A program granting prison inmates with hepatitis C virus infection unrestricted access to direct-acting antiviral therapy nearly eliminated the virus at a correctional facility in Australia less than 2 years after its implementation, according to study findings published in Clinical Infectious Diseases.

Open access to direct-acting antivirals (DAAs) was made available through the Pharmaceutical Benefits Scheme (PBS) — a component of the Australian Government’s National Medicines Policy that subsidizes the cost of certain medications.

PBS expanded access to DAA therapy for people with HCV, including those in the correctional system, in March 2016, according to Sofia R. Bartlett, PhD, researcher in the Viral Hepatitis Clinical Research Program at The Kirby Institute, University of New South Wales in Sydney, Australia, and colleagues. HCV, they noted, is common in correctional facilities, with more than 10% of incarcerated people having the infection worldwide. HCV prevalence is even higher among people who inject drugs (PWID) who are incarcerated, they added.

“The close relationship between injection drug use, incarceration and prevalence of blood-borne viruses makes correctional centers a crucial setting for enhanced DAA therapy access and broad prevention strategies,” Bartlett and colleagues wrote. “Population-level HCV elimination success will require effective HCV treatment and prevention programs among both PWID and people who are incarcerated.”

After unrestricted access to DAA therapy was made available, the Lotus Glen Correctional Center (LGCC) in Queensland initiated a program implementing rapid treatment scale-up for inmates. Within the first 22 months of the program, the proportion of new inmates tested for HCV increased from 83% to 91%. Overall, 125 inmates who tested positive for HCV were offered treatment. Among them, 119 were prescribed interferon-free DAA for 8, 12 or 24 weeks.

Bartlett and colleagues reported that 97% of patients with evaluable treatment outcomes had sustained virologic suppression. They estimated that HCV viremic point prevalence declined from 12.6% before the program, to 4.3% 1 year after implementation and 1.1% 22 months after implementation.

More than 30 patients were lost to follow-up, and reinfections occurred in two LGCC inmates, one patient released from the facility and three transferred to another center, highlighting the risk for ongoing exposure and the need to improve communication liaisons between HCV treatment services in the correctional system and the community, according to the researchers.

“Nonetheless, this study demonstrates that correctional center-based DAA therapy services ... can provide favorable individual and facility population-level outcomes,” they concluded. – by Stephanie Viguers

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Disclosures: Bartlett reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.