Outcomes Of Treatment For Hepatitis C Virus Infection In The Prison Setting In The Traphepc (Treatment As Prevention For Hepatitis C) Program In Iceland

Author: Fridriksdottir RH, Fridjonsdottir H, Alexiusdottir K, Karlsdottir B, Tomasdottir A, Björnsdottir Th, Finnbogadottir AM, Olafsdottir B, Tyrfingsson Th, Runarsdottir V, Bergmann OM, Björnsson ES, Johannsson B, Sigurdardottir B, Heimisdottir M, Olafsson S, Gottfredsson M

Theme: Clinical Research Year: 2017

Background: Hepatitis C virus (HCV) infection is common among prisoners due to high rates of incarceration of people who inject drugs (PWID). In Iceland a nationwide treatment effort was launched in 01/2016, where all HCV patients are offered treatment, including an outreach nurse-led program within the penitentiary system. We evaluated the outcomes during the first 12 months.
Methods: TrapHepC nurses regularly visit the prisons, organize blood tests, conduct brief interviews and measure liver stiffness. Prior to treatment initiation the prisoners are interviewed once by a supervising physician. Starting in June 2016, all inmates at the main prison in Iceland were offered testing and subsequent treatment for HCV with SOF/LDV+/-RBV through October 2016 and SOF/VEL thereafter.
Results: At the initiation of the program, 59 (84%) out of a total of 68 inmates were tested for HCV. Of tested inmates, 17 (29%) were PCR positive, of which 16 accepted treatment. During subsequent screening of new inmates, 13 additional patients have been identified and initiated on treatment, for a total of 29. The mean age is 32 (range 21-51) with 28 (97%) males. All but two (27, or 93%) were PWID, 19 (70%) had injected within 6 months. Of the 29,11 were released and continued treatment and/or follow up outside prison. 26 have completed treatment and are all PCR negative at end of treatment. Of the 18 patients who have reached post-treatment week 12 and for whom data are available, 16 (89%) have achieved SVR12. Relapse or reinfection has occurred in the other 2 subjects; virologic analyses are ongoing.
Conclusion: Treatment for HCV is well accepted and can be delivered safely and effectively in the prison setting. The penitentiary system provides an important opportunity to engage and treat high-risk individuals, and should be an integral part of any national HCV elimination program.

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