Reduced hepatitis C incidence associated with rapid treatment scale-up in Australian prisons: treatment-as-prevention in the SToP-c Study

Author: Behzad Hajarizadeh Jason Grebely Marianne Byrne Pip Marks Janaki Amin Hamish McManus Evan Cunningham Tony Butler Peter Vickerman Natasha Martin John McHutchison Diana Brainard Carla Treloar Georgina Chamber Luke Grant Collete Mcgrath Andrew Lloyd Greg Dore

Theme: Epidemiology and Public Health Research Year: 2021

Background: Limited empirical evidence exists for hepatitis C virus (HCV) treatment-as-prevention. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study assessed HCV treatment-asprevention in four Australian prisons. Methods: People incarcerated in two maximum- (male) and two medium-security prisons (one male, one female) were enrolled from late-2014 to 2019. Following HCV testing, participants were monitored for risk behaviors and HCV, among three sub-populations: 1) uninfected (HCV antibody negative); 2) previously infected (HCV antibody positive, HCV RNA negative); 3) infected (HCV antibody and HCV RNA positive). Uninfected and previously infected (at-risk) participants were followed every 3-6 months for HCV primary infection and re-infection, respectively. Infected participants were assessed for treatment, initially standard of care treatment (by prison health services), followed by directacting antiviral (DAA) treatment scale-up from mid-2017 (12 weeks sofosbuvir/velpatasvir, through SToP-C). HCV incidence was compared between pre- and post-treatment scale-up periods. Results: Of 3,691 participants, 719 (19%) had detectable HCV RNA and 2,965 were at-risk of primary infection (n=2,240) or re-infection (n=725) at baseline. DAA treatment was initiated in 349/499 eligible participants during scale-up. Among at-risk population with longitudinal follow-up (n=1,643; median age 33 years; 82% male), 31% reported injecting drug use in prison. HCV incidence declined by 48%, from 8.31 to 4.35/100 person-years between pre- and post-treatment scale-up periods (Figure) [Incidence Rate Ratio (IRR): 0.52, 95%CI: 0.36, 0.78]. The incidence of primary infection declined from 6.64 to 2.85/100 person-years (IRR: 0.43, 95%CI: 0.25, 0.74), while incidence of reinfection declined from 12.36 to 7.27/100 person-years (IRR: 0.59, 95%CI: 0.35, 1.00). Adjusted analysis indicated 50% reduction in HCV risk between pre- and post-treatment scale-up periods (adjusted Hazard Ratio: 0.50, 95% CI: 0.33, 0.76). Conclusion: DAA treatment scale-up was associated with reduced HCV incidence in prison, indicative of HCV treatment-as-prevention. The findings support broad DAA treatment scale-up among incarcerated populations. Disclosure of Interest Statement: The SToP-C study is a partnership project involving the Kirby Institute (UNSW Sydney), Justice Health and Forensic Mental Health Network, Corrective Services NSW, NSW Health, NSW Users and AIDS Association, Hepatitis NSW and Gilead Sciences, Inc. SToP-C is supported by National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1092547), and Gilead Sciences, Inc. The opinions expressed in this poster are those of the authors and do not necessarily represent those of NHMRC or Gilead Sciences. The Kirby Institute is funded by the Australian Government Department of Health and is affiliated with the Faculty of Medicine, UNSW Sydney. The views expressed in this publication do not necessarily represent the position of the Australian Government. Figure Oct 2014 – Jun 2016 2016 Jul-Dec 2017 Jan-Jun 2017 Jul-Dec 2018 Jan-Jun 2018 Jul-Dec 2019 Jan-Jun 2019 Jul-Dec 0 2 4 6 8 10 12 14 16 HCV incidence (per 100 person-years) Before treatment scale-up After treatment scale-up

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