Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era
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RESEARCH
Continuum of hepatitis C care cascade in prison and following release in the direct‑acting antivirals era Sanam Hariri1†, Heidar Sharafi2†, Mahdi Sheikh3,1, Shahin Merat1, Farnaz Hashemi1, Fatemeh Azimian4, Babak Tamadoni5, Rashid Ramazani4, Mohammad Mehdi Gouya4, Behzad Abbasi1, Mehrzad Tashakorian5, Ramin Alasvand5, Seyed Moayed Alavian2, Hossein Poustchi1* and Reza Malekzadeh1
Abstract Background: People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison. Methods: Between 2017–2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent directacting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12). Results: Overall, from 3485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison, and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR12 = 100%). Conclusions: Integrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of treatment adherence. Future studies should investigate the predictors of engagement with HCV care following release. Keywords: Hepatitis C virus (HCV), HCV treatment, Linkage to care, Prison healthcare, Harm reduction, HCV elimination
*Correspondence: [email protected] † Sanam Hariri and Heidar Sharafi should be considered joint first authors 1 Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117 Tehran, Iran Full list of author information is available at the end of the article
Background Following the introduction of highly effective antiviral agents, the hepatitis C virus (HCV) infection has become curable in the recent decade [1]; hence treatment of infected people has been introduced as a key strategy for disease prevention in communities [2]. Imprisonment and the increased risk of transmission after
© The Author(s) 2020. Open
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