Hepatitis C Micro-Elimination Program in Prisons Across Greece: “Access4All in Greek Prisons”

Author: George Kalamitsis Sotiris Roussos Vana Sypsa Giannis Petalidis Paschalis Vavelidis

Theme: Models of Care Year: 2022

Background: The burden of hepatitis C infection among people living in prisons is high. In
Greek prisons, although people who inject drugs constitute a large proportion of the prisoner
population, there are no available routinely collected data on HCV burden nor an established
procedure for HCV screening/linkage to care.
Description of model of care/intervention: An HCV micro-elimination program (“Access4All
in Greek Prisons”) is implemented in Greek prisons since January 2019 with the aim of
screening for HCV and facilitating linkage to care. Rapid HCV testing was performed, and blood
sample was collected among anti-HCV(+). Linkage to HCV treatment was implemented in
cooperation with the local hepatology clinics (HCV-RNA detection and blood samples
examination). The field coordinator transferred medication from local pharmacies to prisons’
settings. In the three last prisons, incentives (phone cards) were used and awareness
initiatives (informative flyers distribution and in-person communication with inmates before
screening) were applied in order to increase the participation rate.
Effectiveness: During January 2019-January 2022, 2,477 prisoners were tested from nine
prisons. The overall participation rate was 63.8% (range per prison: 17.0%-91.7%). The use of
incentives and awareness creation increased participation from 52.3% (95% CI: 50.3%-54.3%)
to 82.7% (95% CI: 80.6%-84.6%), p<0.001. In total, anti-HCV prevalence was 16.8% (415/2477)
(95% CI: 15.3%-18.3%) (range per prison: 4.0%-23.1%). Almost half of anti-HCV(+) participants
had social security number (60.5%; 251/415). Out of anti-HCV(+) participants with social
security number, 78.1% initiated direct acting antivirals(DAAs) within the prison setting (range
per prison: 32.4%-100.0%).
Conclusion and next steps: Despite the barriers to access to DAAs in Greek prisons, the
program was successful in identifying a large number of imprisoned persons eligible for HCV
treatment and in subsequently linking them to treatment. It is intended to implement the
program in other prisons in Greece in the following months.
Disclosure of Interest Statement:
“Access4All in Greek Prisons” program was supported by Gilead and Gilead Sciences
(COMMIT; COvid-19 unMet MedIcal needs and associated research exTension).
GK, GP, PV have received a grant by Gilead Sciences.
VS has received a grant by Gilead Sciences and AbbVie for the submitted work. She has served
as a lecturer for Gilead, AbbVie, and Janssen.
SR has no conflict of interest to declare.

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