Theme: Epidemiology & Public Health Research Year: 2025
Background:
Prisons are high-risk settings for hepatitis C virus (HCV) infection among people who
inject drugs, given sub-optimal harm reduction access. This includes high risk of HCV reinfection
after successful treatment. Our study evaluates HCV reinfection incidence following direct acting
antiviral (DAA) treatment among people in prison who inject.
Methods:
SHARP-P was an observational cohort study, enrolling people with chronic HCV who
reported injecting drug use in the previous six months and commenced DAA treatment in a prison
network in New South Wales, Australia (2019-021). Justice Health and Forensic Mental Health
Network provides opioid agonist treatment (OAT), but no needle-syringe program. Participants were
assessed every 3-6 months post-treatment for recurrent viremia, classified as: definite reinfection,
possible reinfection, virological failure and undefined (Figure). Reinfection incidence and associated
factors were evaluated.
Results:
Of 201 participants, 154 (77%) had post-treatment follow-up and were included in analyses
(median age 32 years, 20% women, 62% injected drugs in the month pre-enrolment [95% shared
injecting equipment]). Twenty-six episodes of recurrent viremia were classified as: 16 definite
reinfection, 3 possible reinfection, 1 virological failure, and 6 undefined (Figure). During 103 personyears of follow-up, incidence of definite HCV reinfection was 15.5/100 person-years (95%CI, 9.5-
25.3) overall, 19.4/100 person-years (95%CI, 11.2-33.4) among those injecting during follow-up, and
57.9/100 person-years (95%CI, 32.9-101.9) among those sharing injecting equipment. Reinfection
was associated with injecting drug use in the past month (adjusted Incidence Rate Ratio (aIRR) 4.7:
95%CI, 1.5-15.0). Among those injecting during follow-up, reinfection was associated with sharing
injecting equipment in the past month (aIRR 12.3: 95%CI, 1.5-100.2).
Conclusions:
The high HCV reinfection incidence in prisons despite good OAT coverage highlights the
limits of treatment-as-prevention and the need for additional prison-based harm reduction
interventions. The finding that most recurrent viremia is due to reinfection can inform clinical
decision-making.
Disclosure of Interest Statement:
JG has received research grants from AbbVie, Biolytical, Cepheid, Gilead and Hologic, and has received honoraria from AbbVie, Abbott, Cepheid, Gilead and Roche outside the submitted work. LL has received speaker fees from AbbVie Pty Ltd. CT has received speaker fees from Gilead. GM reports grants from ViiV and Janssen, received honororia from ViiV and Gilead and participated on a Data Safety Monitoring Board for ViiV. GJD reports research support from Gilead and Abbvie. ARL has received investigator-initiated research grants from Gilead Sciences and AbbVie Pty Ltd.
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