Does Australia’s Policy Landscape Support HCV Treatment as Prevention in the Prison Setting in the New DAA Era?

Author: Lafferty L, Wild C, Rance J, Treloar C

Theme: Social Science & Policy Research Year: 2017

Background: Hepatitis C (HCV) is a global public health concern. There is a global prevalence of 15.1% of the world’s prisoner population, making those incarcerated a priority population for treatment. New therapies, known as directing-acting antivirals (DAAs), became available under Australia’s universal healthcare scheme on 1 March 2016. Australia is the first country to provide HCV treatment without restrictions (e.g., injecting drug history, liver disease stage, incarceration status). This creates an opportune time to trial treatment as prevention (TasP) as an elimination strategy for HCV in prison settings. But do Australia’s policies support treatment scale-up to achieve elimination among this priority population?

Methods: A systematic search was conducted using Google and other web-based search functions to locate all publicly available policies in each Australian state and territory related to HCV health and HCV-related prison health. Inductive and deductive analyses were conducted for each jurisdiction, with documents being assessed against a set of five a priori criteria. Documents included in the analysis were current at 28 Aug 2016, or 6 months following treatment availability.

Results: A total of 18 documents were located, including both health (n=10) and prison health (n=8) documents relevant to HCV. Jurisdictions ranged in their commitments and consistencies for delivering HCV harm reduction strategies and treatment availability within the prison setting. Both reinfection and treatment as prevention were mentioned in only two policies.

Conclusion: Few jurisdictions have updated or published HCV-related health or prison / prisoner health policies following availability of DAAs. Current policies do not provide effective support for implementing treatment scale-up that could be possible under universal access to HCV treatment among this priority population.

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