Hepatitis C in the custodial settings- key takeaways from INHSU 2022

Throughout the 10th International Conference on Health and Hepatitis in Substance Users – INHSU 2022 – we welcomed experts to discuss hepatitis C in custodial settings, where a high prevalence of HCV infection is common.

Here, we summarise the findings from speakers from Greece, the UK, and Australia who share insightful case studies on programs that are helping to test, treat, and cure HCV in prisons.

If you’re interested in the health and well-being of people who use drugs in the prison setting, you can join our special interest group INHSU Prisons, here


Micro-eliminating HCV in 8 diverse prisons that serve a general population of 3.7 million in the Yorkshire region of England

Nichola Royal, Practice Plus Group Ltd, UK  


Nichola presented the National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) by 2025. With a reported HCV prevalence of about 6% in male prisons, and about 12% in female prisons, secure environments are an essential component of this elimination plan. A partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT) was formed in 2019. 

This partnership works with prison and hospital teams to optimise test and treat pathways for new prison admissions. In addition, whole prison HCV Intensive Test and Treat events (HITT programs) were run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. 

As a result of this work, HCV screening, within 7 days of prison entry, increased from 27% in May 2019 to 93% in January 2022. In addition, a number of prisons have achieved micro-elimination status.


Implementation of Dried Blood Spot Testing for HIV and Hepatitis C: The NSW DBS Pilot Study: A Client-Centred Alternative to Traditional Health Care

Anna Conway, The Kirby Institute, UNSW Sydney, Australia 

Dried Blood Spot (DBS) sampling allows people to get tested outside of traditional healthcare settings, reducing the stigma that can stop people from getting tested for HCV. Anna Conway presented The New South Wales DBS Pilot which offers testing for HIV AB and/or HCV RNA via 1) online self-registration with a DBS collection kit delivered and returned by conventional postal service; or 2) assisted DBS sample collection at community health sites or prison. 

The NSW DBS Pilot demonstrates the feasibility of using DBS to promote HCV testing and treatment in community and prison settings: 

  • Between November 2016 and December 2020, 5,960 people tested for HCV and 15% had detectable HCV RNA (878/5,960) 
  • Overall, 45% (n=393/878) of people with current HCV infection initiated treatment within six months 
  • Treatment initiation was higher in prison (61%) than assisted registration in community (27%) or online self-registration (13%) 


Hepatitis C micro-elimination program in prisons across Greece: ”Access4All in Greek Prisons”

George Kalamitsis, Hellenic Liver Patients Association “Prometheus”, Greece 

“Prometheus” is the only Civil Society Organisation in Greece that implements public health programs inside prisons’ settings. Despite the fact that prisons are an environment which offers a great opportunity for massive public health interventions, during three years of “ACCESS4ALL IN GREEK PRISONS”, barriers were encountered which resulted either in beneficiaries’ hesitancy to participate, or in exclusions from receiving treatment. In response, new approaches and adaptation of strategy was undertaken, going through “real world” challenges. Prometheus managed to overcome barriers and increase effectiveness, via a more empathetic approach, advocacy and awareness initiatives, as well as incentives provision.  

Since the COVID-19 pandemic seriously affected and delayed the national HCV elimination strategy, the organisation managed to revive and re-establish it, under extreme circumstances such as lockdowns and restrictions. All in all, “ACCESS4ALL IN GREEK PRISONS” is a lasting case study and an example of what needs to change, since the gap between patients and the public healthcare is getting even bigger when it comes to marginalised populations. With the appropriate mapping of barriers and the coordination of stakeholders, Prometheus became the “missing link” at the cascade of care, offering precious and long-lasting data to contribute to “HepC free” prisons by implementing a cost-effective methodology. 


Hepatitis C treatment uptake following a Hepatitis C Point-of-Care testing ”Blitz” at a prison in Queensland, Australia: The Woodford Prison testing campaign

Mim O’Flynn, Kombi Clinic Ltd, Australia  

HCV point-of-care testing blitzes allow key populations such as people in prison to be tested and treated over a short duration. Collaborative partnerships, tenacity and understanding of working in corrections, a passionate team and the ability to link multiple GeneXpert IV platforms were key to the success of this fifth Kombi-led testing campaign. Scaling up HCV testing and treatment in prisons, increasing access to OST and establishing a custodial NSP program will facilitate HCV elimination.  

  • The blitz was carried out over nine days with four machines 
  • 673 men were tested, equating to 62% of the prison population 
  • 27% were found to be RNA positive (n=182/673) and 98% of all RNA-positive individuals were scripted within four weeks 
  • Key learnings were that stakeholder support is critical and that it is important to have an alternative plan ready as the backup to deal with events such as lockdowns 
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