Theme: Epidemiology & Public Health Research Year: 2017
HCV transmission is high in prisons. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study in New South Wales, Australia consists of two major phases: i)Surveillance, HCV status and risk behaviour are evaluated at study entry and monitored longitudinally; ii)Treatment scale-up, participants with detected HCV-RNA are offered sofosbuvir/velpatasvir. This analysis assessed HCV incidence in two SToP-C maximum-security prisons before treatment scale-up.
Surveillance phase data of participants enrolled during October 2014-November 2016 with at least one follow-up visit was used. Participants were screened for HCV-antibody (Ab) and HCV-RNA at enrolment. HCV-Ab or HCV-RNA negative participants were tested every six months. Those with HCV-Ab negative and HCV-Ab positive/HCV-RNA negative were considered at risk of HCV primary infection and reinfection, respectively.
Among 748 participants screened, 171 were included in analysis (122 and 49 were at risk of HCV primary infection and reinfection, respectively; Median age 36 years; median duration of stay at the prison 4 years). During 178 person-years (py) of follow-up, 9 incident infections were observed, including 5 primary and 4 reinfections. HCV incidence was 5.1/100 py (95%CI: 2.6-9.7). All 9 participants with incident HCV reported ever injecting drug use (IDU), and 5 reported IDU in the past month in prison. Among those reporting ever IDU, overall HCV incidence was 13.0/100 py (95% CI: 6.8-25.0); primary infection incidence was 18.6/100 py (95% CI: 7.7-44.7); and reinfection incidence was 9.4/100 py (95% CI: 3.5-25.1). Among those reporting IDU in the past month, HCV incidence was 35.5/100 py (95% CI: 14.8-85.3), while all participants with incident HCV (n=5) reported sharing needle/syringe.
High HCV incidence was found in SToP-C maximum-security prisons, supporting the need for comprehensive prevention strategies, including harm reduction and a HCV treatment-as-prevention evaluation. HCV transmission was primarily associated with IDU, particularly recent IDU in prison.