HCV reinfection common in Australian prisons, study finds
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Hepatitis C virus reinfection was common in five Australian prisons, a study found — especially among injection drug users, highlighting the need for post-treatment surveillance and increased services, researchers said.
Research has shown that HCV is prevalent in United States prisons, with around 30% of the country’s HCV-infected people passing through the prison system each year. Universal HCV testing and treatment programs in prisons have been shown to be “cost-effective, but costly,” with high cure rates.
The prisons in the Australian study all had opioid agonist therapy programs but not needle or syringe programs, researchers reported in Clinical Infectious Diseases.
“People who inject drugs are incarcerated at high rates for drug-related crimes and the burden of hepatitis C virus infection in prisons exceeds that observed in the community,” Joanne M. Carson, a PhD candidate at the University of New South Wales in Sydney, Australia, told Healio.
“Direct acting antiviral treatment is being scaled up in Australian prisons as part of the effort to eliminate HCV as a major public health threat by 2030,” Carson said. “In community settings there is high coverage of harm reduction services, such as opioid agonist therapy and needle and syringe programs that can reduce HCV transmission among people who inject drugs.”
However, there is limited access to opioid agonist therapy and no access to needle and syringe programs in prisons, Carson said.
“We were concerned there may be a high risk of post-treatment reinfection within prisons and that this may negatively impact HCV elimination efforts,” she said.
Carson and colleagues enrolled people incarcerated in four prisons between 2014 and 2019 in the Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study. They followed the participants every 3 to 6 months to identify any reinfections.
Among the 388 patients who received treatment, 161 had available post-treatment follow-up and were included in the analysis. During the 145 person-years (PY) of follow-up, testing identified 18 cases of reinfection for a reinfection incidence of 12.5/100 PY overall (95% CI, 7.9-19.8). That increased to 28.7/100 PY among people with recent injection drug use and needle or syringe sharing (95% CI, 16.3-50.6).
An adjusted analysis found that injection drug use within the last month with needle or syringe sharing was associated with an increased risk for reinfection (adjusted HR = 14.62; 95% CI, 1.84-116.28), whereas longer HCV testing interval was associated with decreased risk (aHR = 0.41 per each month increase; 95% CI, 0.26-0.64).
“Prison-based delivery of HCV treatment has the potential to contribute substantially to HCV elimination efforts among people who inject drugs,” Carson said. “The findings of the SToP-C study demonstrate the need for regular post-treatment surveillance to detect and retreat reinfection early and support enhanced access to harm reduction services, including improved opioid agonist therapy coverage and needle and syringe programs, within prisons.”
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