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European survey asserts insufficient HCV prevention in prisons

Results of a survey of liver patient groups from 25 European countries showed that a minority of European prisons provide adequate infectious disease prevention, such as harm reduction programs and hepatitis C screening.

“Given the high prevalence of hepatitis C virus (HCV) among prisoners, disease prevention measures, such as opioid substitution therapy and needle and syringe programs, are currently insufficient in European prison settings,” Rob Bielen, MD, from the Hasselt University in Belgium, and colleagues wrote. “Only a minority of HCV-infected patients in prisons have access to direct-acting antiviral therapy, which can easily and effectively cure HCV.”

The European Liver Patients’ Association commissioned the Hep-CORE study, which was conducted between 2016 and 2017.

Twenty-one countries reported that testing and screening for HCV is provided in at least one prison; however, 16 countries reported no specific HCV screening policy for prisoners as a high-risk population and testing is often only offered if requested by the prisoner or a medical doctor.

Twenty-one countries reported HCV treatment is provided in at least one prison. Nine countries reported the availability of HCV treatment in prisons, while the other 16 could not. Slovakia, Slovenia, Spain, Sweden and the United Kingdom provide HCV treatment in all prisons, whereas Austria, Hungary, Portugal and Ukraine provide HCV treatment in less than half of their country’s prisons.

Spain and Romania have needle and syringe programs (NSP), although Romania does require formal registration and reported no currently enrolled prisoners. Germany and Macedonia reported limited availability of NSPs. The remaining 21 countries have no NSP programs.

Eleven countries have opioid substitutions therapy (OST) available in prisons in all parts of the country; however, Denmark, Finland, the Netherlands, Poland and Serbia have additional requirements for the programs, such as abstinence or limitation to those who initiated OST prior to incarceration. Bosnia, Slovakia, Turkey and Ukraine have no available OST programs.

“Scaled-up opt-out testing during or upon entry to prison settings, linked to prompt treatment, would be a major step towards the elimination of HCV and reduce the further spread of infection to people who inject drugs, other prisoners or to the general population upon release,” Bielen and colleagues concluded. “Although recommendations have been formulated specifically in relation to HCV management in prisons, implementation efforts must be scaled up in order to eliminate HCV as a public health threat by 2030 in line with targets set by WHO and adopted by all European Member States.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.