Theme: Epidemiology & Public Health Research Year: 2018
Background:
While the burden of chronic hepatitis C virus (HCV) infection is significantly higher among
people in prisons compared to the general population, testing and treatment uptake remain
suboptimal. The aim of this systematic review was to evaluate interventions to enhance HCV
testing, linkage to care and treatment uptake among people in prisons, a key population for
HCV elimination.
Methods:
We searched Medline, Embase and the Cochrane Central Register of Controlled Trials for
English language articles published between January 2007 and November 2017. Studies
evaluating interventions to enhance HCV testing, linkage and treatment uptake for people in
prison were included. Two independent reviewers evaluated articles selected for full-text
review and extracted data for analysis. Disagreements were resolved by consensus.
Results:
A total of 475 unique articles were identified, 29 were retrieved for full text review and six
were included. All but one study focused on testing in prison settings. Only two were
randomized controlled trials (RCTs); the remainder were primarily single arm uncontrolled
trials. Interventions to enhance HCV testing in prison settings included combination riskbased and birth-cohort screening strategies, on-site nurse-led opt-in screening clinics with
pre-test counseling and education, and systematic dried blood spot (DBS) testing. All
interventions increased HCV testing, albeit risks for study biases were high. Only DBS
interventions were evaluated using RCTs; one study demonstrated increased HCV testing
by 14.5%; the other showed no effect. Interventions to enhance linkage included facilitated
referral for HCV assessment and scheduling of specialist appointments. All but one study
was conducted in the pre-direct-acting antiviral (DAA) era; no studies were conducted in lowor middle-income countries.
Conclusion:
While the majority of studies have focused on improving access to HCV testing in the
interferon era, rigorous controlled studies evaluating interventions to improve testing, linkage
and treatment uptake in the DAA era are necessary.
Disclosure of Interest Statement:
NK has received consulting fees from ViiV Healthcare, Merck and Gilead; research funding
from ViiV Healthcare and Gilead; and payment for lectures from Gilead. MK has received
consulting fees from ViiV Healthcare, BMS, Merck, Gilead and AbbVie; and research funding
from Merck, Gilead and ViiV Healthcare. BL has received consulting fees from ViiV
Healthcare and Gilead; research funding from Merck, Gilead and Abbvie; and payment for
lectures from Merck and Gilead. GS has received consulting fees from Merck and BMS;
research funding from Merck; and payment for lectures from Merck, BMS, Gilead and
Abbvie. JC has received consulting fees from ViiV Healthcare and Gilead; research funding
from ViiV Healthcare, Merck and Gilead; and payment for lectures from Gilead.