Hepatitis C in Prisons in France, Situational Analysis in 2015: Efficient Screening, Undertreatment

Author: Remy, André-Jean

Theme: Epidemiology & Public Health Research Year: 2017

Background : Prevalence of viral hepatitis C is high in prison environment in France, estimated of 4,8%. Inmate health care falls under USMP, hospital specific units. Access to antiviral C treatment for inmates has been difficult, with less than 20% of treated patients.
Methods: 2015 national survey of practices among 168 USMPs
Results: 64 valid surveys were available representing a 38% interest with a 39% coverage of inmate population. Total active file patients with hepatitis C was of 1115 (average of 20), prevalence of 4,3%. HCV screening was systematically proposed to new inmates in 98% of USMPs. Average rate of done screenings was of 70%, with72% of systematic delivery of results. POCT were done in 12,5% of USMP. FIBROTEST® could be done for 80% of USMP and FIBROSCAN® for 84% (but only 23% on-site), representing 61% of people with hepatitis C. On-site hepatologist consultation was available in 56% of USMP adding to it 21 mutual staffs; 66% of USMP started at least one treatment by DAA: 130 patients were beneficiary. DAA dispensing is daily (79%), weekly (17%) and monthly (4%). 61% of USMP would systematically organize a post therapeutic consultation and 38% a prevention/risk reduction one.
Conclusion: Screening is efficient in the care of hepatitis C in prison environment in France, pre and post-therapeutic care organization is consistent with the guidelines but number of people affected who benefit from it remains insufficient. Screening is systematically proposed even though achievement rate is a less two-thirds. Result delivery was not systematic. Fibrosis non-invasive diagnosis methods are frequently used with however a limited access to a FIBROSCAN®. Link between hepatologist services and USMP are strong. Number of patients treated is low despite 2/3 USMP started a treatment. Prison environment constitutes a care and hepatitis C treatment location for vulnerable population with difficulty to access care places in community.

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