Programme to eliminate hepatitis C in a network of 49 prisons through multi-stakeholder partnership.


Author: Andy Jones, Nichola Royal, Emily Mongale, Julie Henderson, Kate Abraham, Arran Ludlow-Rhodes, Louise Missen, Andrew Milner, Rob Cheetham, Arran Ludlow-rhodes

Theme: Models of Care Year: 2023

Background:
National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) in England by 2025 and has selected prisons as one of its areas of focus to achieve this goal. In 2019, NHSE defined micro-elimination in prisons as ≥95% all residents tested within previous 12 months, ≥90% RNA+ residents initiated on treatment and a process to regularly review performance.

Description of model of care/intervention:
To support NHSE in their HCV Elimination Program, a partnership between Gilead, Practice Plus Group (PPG) and the Hepatitis C Trust was formed in 2019. PPG provides healthcare to 42 English prisons. PPG Regional BBV Lead Nurses, and Gilead Medical Scientists worked with prison and HCV stakeholders to optimise test and treat pathways for new prison admissions. Whole prison test and treat events were also run-in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented

Effectiveness:
4 years into this partnership, pathway optimisation has increased screening within 7 days of prison entry across all PPG sites/nationally from 41% in May 2019 to 87% in February 2023. 2,712 patients have been diagnosed as RNA+ with 2,533 (93%) being initiated on treatment. Of the 30,739 residents in February 2023, 26,159 have been tested in the previous 12 months and 90% who were RNA+ in the last 12 months were on or completed treatment. RNA prevalence decreased from 4.75% in 2019 to 1.78% in 2020, a 62% reduction, despite antibody rates remaining stable.

Conclusion and next steps:
This project has demonstrated that micro-elimination of HCV in prisons is possible through multi-stakeholder pathway optimisation. Reductions in RNA prevalence are likely to be a result of multiple elimination initiatives including prisons and drug treatment services. Prisons may be a useful setting along with emergency room testing, to assess national progress to HCV elimination. 

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