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Nurse-led HCV care model results in 95% or higher SVR rates in prison

A decentralized, nurse-led model of hepatitis C care with direct-acting antivirals was significantly effective and led to high levels of sustained virologic response in a large cohort of inmates, according to a recently published study.

“The prevalence of hepatitis C is higher in prisoners than in the general population, reflecting the criminalization of drug use and the frequent detention of [people who inject drugs (PWIDs)],” Timothy Papaluca, MBBS, FRACP, from the St Vincent’s Hospital and the University of Melbourne, Australia, and colleagues wrote. “This population has not typically been well engaged with specialist care, highlighting the need to develop new models of care for hepatitis C among marginalized, high transmitting populations.”

During a 13-month period, evaluation of 949 incarcerated patients revealed 562 patients eligible for treatment. Most of those deemed ineligible had an insufficient period of remaining incarceration to complete treatment.

The per protocol SVR rate was 96% and SVR rates exceeded 95% for all genotypes. While intention-to-treat SVR rates were lower (72%), the most common reason for not achieving SVR was loss to follow-up due to release from prison (90%). Three of 11 patients whose treatment failure was due to virological relapse had treatment interruptions that lasted longer than 1 week.

“The key features of the program that likely support its success include the nurse-led model delivering DAA therapy locally, the state-wide coverage across all correctional facilities, the use of information technology including telemedicine and a central electronic medical record, a centralized pharmacy distribution with real-time prisoner tracking, and federal government policy supporting prisoner access to DAAs,” Papaluca and colleagues wrote.

Most patients were considered “low risk” and suitable for treatment based on nurse-led evaluation only and did not require a formal hepatologist assessment (82%). The remaining “higher risk” patients required either face-to-face consultation, telemedicine hepatologist consultation, or both. SVR rates were comparable between low-risk and high-risk patients.

While the decentralized, nurse-led model of care decreased the need for most patients to attend a central prison or hospital for HCV assessment and treatment, 26% had at least one prison transfer during DAA therapy. However, prison transfer frequency did not correlate with diminished SVR outcomes.

“Although many countries continue to mandate specialist physician management for hepatitis C therapy initiation, our data demonstrate that nurse-led treatment is safe and effective in the correctional setting, with only 18% of assessed prisoners requiring specialist consultation,” Papaluca and colleagues concluded. – by Talitha Bennett

Disclosure: Papaluca has received honoraria from Merck. Please see the full study for the other authors’ relevant financial disclosures.