Female prisons ‘main reservoir’ for hepatitis C, key target for elimination initiatives
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LONDON — A high intensity test and treat initiative for hepatitis C elimination in England proved to be beneficial for testing and treating incarcerated individuals, according to results at the International Liver Congress.
“The [National Health Service] hepatitis C elimination program is working toward a shared goal of eliminating hepatitis C as a public health issue, in line with the proposed WHO goal, by 2030,” Beatrice Emmanouil, PhD, from NHS England, told attendees. “Prison populations are known to have a higher rate of people living with a hepatitis C infection compared to the general public and are believed to be the main reservoir of infection.”
Emmanouil and a team of NHS staff, nurses and peers who experienced HCV and incarceration went to prisons to offer HCV testing to the entire prison population using prison-wing-based testing with point of care antibody tests. They successfully completed 34 high intensity test and treat (HITT) program initiatives between June 2019 and September 2021 in seven female and 27 male prisons in England, although they were unable to access the prisons for approximately 6 to 9 months because of the COVID-19 pandemic.
Of 23,388 people in the prison population, 19,049 inmates were tested and 1,234 tested positive for HCV antibodies. Those individuals underwent either blood draws or dried blood spot-testing for confirmation of viremia. Within 2 weeks, those who were infected were provided therapy with direct acting antivirals — and often on the same day — using point of care HCV RNA testing and pangenotypic medication.
Of the inmates who tested positive for antibodies, 175 also tested positive for the presence of HCV RNA. All patients with infection began treatment.
“Our data suggests that there are some subtle but significant differences between female and male prisons,” Emmanouil said. “For instance, the uptake of the testing, the presence of antibodies and the prevalence of hepatitis C were all higher among female prisons compared to male ones.”
The researchers also observed significant variation in hepatitis C prevalence as well as varying uptake of HITT initiatives across different types of prisons.
“Testing was higher in close category prisons compared to more open prisons, in which male prisoners can actually leave to work in the community during the times when HITT was offered,” Emmanouil said. “We also found that the prevalence was higher in male remand prisons, where prisoners go to await sentencing or await relocation, as there is a more chaotic population going in and out compared to settlement prisons where the population is more static.”
However, female prisons consistently exhibited higher rates of hepatitis C than their male counterparts, Emmanouil noted. “We found that the prevalence was higher in female closed prisons compared to open ones — in fact, it was the highest we found across the country.”
She added: “This model has allowed us to get into prisons and get people treated, and as result, I think we are on course to eliminate hepatitis C in prisons. We have almost used HITT in almost all female prisons and are well on our way to eliminating hepatitis C in male prisons as well.”
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Emmanouil B, et al. Abstract OS053. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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