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Treating HCV in prison ‘microenvironment’ reduces transmission

Growing evidence supports the overall benefits and cost-effective outcomes of testing for and treating hepatitis C in the prison “microenvironment,” according to a review of recent studies.

“The prison microenvironment is thought to be a promising location to intervene in the care of blood-borne transmitted diseases since this population carries a high prevalence of disease, commonly engage in high-risk behaviors, and could be readily accessible by providers for testing and treatment,” Joseph S. Redman, MD, PhD, and Richard K. Sterling, MD, MSc, FACG, from the Virginia Commonwealth University, wrote in their review.

Based on established evidence that HIV eradication efforts in prison systems has improved overall disease burden and reduced transmission in a high-risk population, Redman and Sterling aimed to verify if the same could be seen from HCV testing and treatment.

“The prison system may represent the only formal access many of these patients have to specialized healthcare,” the authors wrote. “Linkage to care post-incarcerations is also very low, indicating that treatment is best addressed during the period of imprisonment.”

Redman and Sterling found a recent study performed in a single Spanish prison system. In the study, 99.5% of inmates agreed to testing and subsequent treatment if found to be viremic with HCV. Of the 69 patients who underwent treatment with Harvoni (sofosbuvir/ledipasvir, Gilead Sciences), 64 achieved sustained virologic response with two patients lost to follow-up.

“Inmate willingness to accept treatment was high in this study, and may reflect growing appreciation for the ease of DAA therapy and growing acceptance of telemedicine,” the authors wrote.”

Researchers from the Spanish study also noted that while the cost of treatment was expensive — approximately $9,467 per inmate — they were confident that treating HCV in the microenvironment could ultimately be offset by reduced transmission rates and overall decline in disease prevalence, providing lower societal costs associated with advanced liver disease.

Other studies included reports from Australia, which recently implemented unrestrained access to DAA therapy including provisions for prisoners.

Researchers from Australia have reported multiple barriers, including a lack of perceived illness or awareness of HCV treatments, lack of access to providers, and fear of stigma often linked to high-risk behaviors.

Despite the barriers, however, providers in a study of a single large facility reported that HCV viremia decreased from 12% to 1% over 22 months of observation. Additionally, the prevalence of viremia in new entrants decreased from 4% to 1.7%.

“Treating chronic HCV in a ‘captive’ microenvironment, such as prison, offers the opportunity to treat a high-risk population,” Redman and Sterling wrote. “If coupled with risk-reduction behavior, this model could significantly reduce the overall burden of HCV in our society.” – by Talitha Bennett

Disclosure: Sterling reports research support from Gilead, AbbVie, Abbott, Roche and Merck, and serving on advisory committees for Pfizer, Baxter, Gilead and AbbVie.