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J Hepatol. 2019 Jan 14. pii: S0168-8278(19)30024-8. doi: 10.1016/j.jhep.2019.01.012. [Epub ahead of print]

Outcomes of treatment for hepatitis C in prisoners using a nurse-led, state-wide model of care.

Author information

1
Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia.
2
Burnet Institute, Melbourne, Australia.
3
Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Australia.
4
Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia; Burnet Institute, Melbourne, Australia.
5
Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia.
6
Kirby Institute, University of New South Wales, Australia.
7
Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia.
8
Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia. Electronic address: thompson@svha.org.au.

Abstract

BACKGROUND:

Treatment programs for people who inject drugs (PWID), including prisoners, are important for achieving hepatitis C elimination targets. There are multiple barriers to treatment of hepatitis C in prisons, including access to specialist physicians, testing and antiviral therapy, short prison sentences, and frequent inter-prison transfer. A state-wide program for assessment and management of hepatitis C was developed in Victoria, Australia to improve access to care for prisoners. This nurse-led model of care is supported by telemedicine to provide decentralised care within all prisons in the state.

METHODS:

We prospectively evaluated the feasibility and efficacy of the nurse-led model of care for hepatitis C within the 14 adult prisons over a 13-month period. The primary end point was sustained virological response at week 12 post-treatment (SVR12) using per protocol analysis.

RESULTS:

There were 416 prisoners included in the analysis. The median age was 41 years, 90% were male, 50% had genotype 3 and 44% genotype 1 hepatitis C and 21% had cirrhosis. Injecting drug use was reported by 68% in the month prior to prison entry, 54% were receiving opioid substitution therapy, and 86% reported never previously engaging with specialist HCV care. Treatment duration was eight weeks in 24%, 12 weeks in 59%, and 24 weeks in 16% of treatment courses. The SVR12 rate was 96% (301/313) per-protocol. Inter-prison transfer occurred during 26% courses of treatment, but was not associated with lower SVR12 rates. No treatment-related serious adverse events occurred.

CONCLUSION:

Hepatitis C treatment using a decentralised, nurse-led model of care is highly effective and can reach large numbers of prisoners. Large scale prison treatment programs should be considered to support hepatitis C elimination efforts.

LAY SUMMARY:

There is a high burden of hepatitis C infection among prisoners worldwide. Prisoners who continue to inject drugs are also at risk of developing new infections. For this reason, the prison setting provides an opportunity to treat those people at greatest risk of infection and to stop transmission to others. We developed a new method of providing hepatitis C treatment to prisoners, in which nurses rather than doctors assessed prisoners locally at each prison site. Treatment was safe and most prisoners were cured. Such programs will contribute greatly to achieving the World Health Organisation's Hepatitis C Elimination goals.

KEYWORDS:

Direct acting antiviral; Elimination; Hepatitis C; People who inject drugs; Prisoner

PMID:
30654067
DOI:
10.1016/j.jhep.2019.01.012

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