Theme: Social Science & Policy Research Year: 2018
Background:
The issue of reinfection and retreatment may prove crucial to hepatitis C (HCV) eliminations
efforts. While the subject has been the source of considerable discussion in community and
clinical circles, little is known about the attitudes of prisoners. With prisons set to serve as
test cases for ‘treatment as prevention’ (TasP) strategies, this presentation examines the
perceptions and possible implications of reinfection risk among prisoner participants from the
first, real-world trial of HCV TasP in prison: Australia’s Surveillance and Treatment of
Prisoners with Hepatitis C (SToP-C) study.
Methods:
Participants were recruited from three male correctional facilities in New South Wales, one
minimum and two maximum security. Thirty prisoners (n=30) were interviewed in depth
following the completion of direct-acting antiviral therapy. As part of the interview schedule,
participants were asked to comment on the current national prescribing guidelines permitting
unlimited treatment in the event of reinfection(s).
Results:
Underpinning the range of participant responses was a shared, tacit recognition of the
absence of adequate primary prevention measures in prison. Reinfection was considered an
almost inevitable outcome of injecting drug use while incarcerated and in this context most
prisoners endorsed the merits of retreatment. Interestingly, participants speculated that was
treatment to be offered as a ‘once only’ opportunity, that would likely affect decision-making
among fellow prisoners, with some opting to delay treatment for fear of reinfection,
potentially affecting broader TasP efforts.
Conclusion:
Australia has led the way internationally in securing universal access to new therapies,
including retreatment if required. While our findings inevitably reflect the uniqueness of the
prison setting, they nevertheless emphasise the importance of a broader public health
strategy that includes a focus on the issue of reinfection during treatment discussions with
patients (both in the community and prison) and the promotion of retreatment if required.
Disclosure of Interest Statement:
The authors have no conflict of interest to declare.