Theme: Epidemiology & Public Health Research Year: 2024
Background: This thesis focuses on the assessment of HCV elimination from the first prison in Slovakia. Slovakia is one of the countries with the lowest prevalence of HCV in the population, with the highest prevalence of the disease among IDU* and incarcerated persons as in other countries. Changing the criteria for initiating treatment allowed us to implement a pilot project to eliminate hepatitis C in one of the prisons. Until recently, HCV treatment could only be initiated if one year of drug abstinence at 3-month intervals was documented and the patient could not have health insurance debt. Today, these obstacles to initiating treatment have been removed.
Methods: Between April 9-11, 2024, 471 convicts were screened with a rapid immunochromatographic test for the detection of antigens from capillary blood. 35 convicts were anti-HCV positive, 1 refused further testing, 1 was urgently hospitalized for psychiatric illness, and 5 were discharged. 28 convicts were tested for HCV RNA PCR of whom 23 were positive, representing 82% of the sample of tested patients. Of the 23 HCV RNA positive, 22 admitted to injection drug use. Currently, 19 convicts are approved for treatment, 4 infected will no longer receive treatment due to their short sentence.
Results: We evaluated up to 14% HCV RNA positive (539/73) compared to 0.1% HCV RNA positive in the general population. Although at-risk individuals were actively sought in this prison, this proved insufficient as not every individual evaluated would admit to risky behavior.
Conclusion: The need to test all incoming prisoners has been confirmed and is also part of the new national action plan approved by the Slovak government on December 20, 2023.4 Achieving micro-elimination in the prison setting is the pathway to eliminating hepatitis C in Slovakia.