Theme: Clinical Research Year: 2017
Background: Hepatitis C virus (HCV) infection is common among prisoners due to high rates of incarceration of people who inject drugs (PWID). In Iceland a nationwide treatment effort was launched in 01/2016, where all HCV patients are offered treatment, including an outreach nurse-led program within the penitentiary system. We evaluated the outcomes during the first 12 months.
Methods: TrapHepC nurses regularly visit the prisons, organize blood tests, conduct brief interviews and measure liver stiffness. Prior to treatment initiation the prisoners are interviewed once by a supervising physician. Starting in June 2016, all inmates at the main prison in Iceland were offered testing and subsequent treatment for HCV with SOF/LDV+/-RBV through October 2016 and SOF/VEL thereafter.
Results: At the initiation of the program, 59 (84%) out of a total of 68 inmates were tested for HCV. Of tested inmates, 17 (29%) were PCR positive, of which 16 accepted treatment. During subsequent screening of new inmates, 13 additional patients have been identified and initiated on treatment, for a total of 29. The mean age is 32 (range 21-51) with 28 (97%) males. All but two (27, or 93%) were PWID, 19 (70%) had injected within 6 months. Of the 29,11 were released and continued treatment and/or follow up outside prison. 26 have completed treatment and are all PCR negative at end of treatment. Of the 18 patients who have reached post-treatment week 12 and for whom data are available, 16 (89%) have achieved SVR12. Relapse or reinfection has occurred in the other 2 subjects; virologic analyses are ongoing.
Conclusion: Treatment for HCV is well accepted and can be delivered safely and effectively in the prison setting. The penitentiary system provides an important opportunity to engage and treat high-risk individuals, and should be an integral part of any national HCV elimination program.