Enhancing treatment uptake for hepatitis C virus (HCV) infection through high intensity point-of-care HCV testing in prisons in Queensland, Australia

Author: Mim O'Flynn, Matthew Young, Jonathan O'Loan, Winnie Nguyen, Dorrit Grimstrup, Corey Markus, Susan Matthews, Jae Williams, Maria Martinez, David Silk, Simon Comben, Stephanie Davey, Andrew Lloyd, Evan Cunningham, Jason Grebely

Theme: Models of Care Year: 2023

Background: Elimination of HCV among people in prison, necessitates phlebotomy and pathology pathways often requiring multiple visits with loss to follow-up. Overcoming these challenges, high intensity onsite point-of-care testing campaigns were initiated. This study evaluated treatment uptake following HCV point-of-care testing campaigns at six prisons in Queensland, Australia.

Methods: HCV testing campaigns included male and female people in prison receiving point-of-care HCV RNA testing across six prisons in Queensland, Australia, including one revisited prison. Between March 2022 and February 2023 testing occurred over a total of 36 days. Project was conducted through partnership with the Queensland Health, Queensland Corrections, Kombi Clinic, community-based organisations, point-of-care quality management providers and research institutions. Participants received onsite point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick assay with six Cepheid GeneXpert IV platforms), linkage to nursing/physician care, and HCV treatment. Primary outcome was HCV treatment uptake within four weeks of testing.

Results: Between 28 March 2022 and 10 February 2023, 2,629 people received point-of-care RNA testing, representing 57% (range, 37%-90%) of all people in the prisons at the time. This included 2,301 males (median age, 35 years; 39% Aboriginal and/or Torres Strait Islander; 66% history of injecting drug use) and 328 females (median age 35 years; 50% Aboriginal and/or Torres Strait Islander; 69% history of injecting drug use). HCV RNA prevalence differed between males (22%, 512/2301) and females (4%, 12/328; p<0.001). HCV treatment uptake was similar between males (91%, 464/512) and females (92%, 11/12; p=0.902).

Conclusions: GeneXpert HCV point-of-care testing through large-scale high intensity testing programs within prisons led to high HCV treatment uptake. These campaigns can achieve high coverage rates within correctional environments, facilitating a significant proportion of people to be rapidly tested and coupled with timely delivery of treatment. Collaboration with partners and stakeholders is critical to the success of these campaigns.

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