Hepatitis C virus infection in jail: Difficult-to-reach, not to-treat. Results of a point-of-care screening and treatment program

• Published in: Digestive and liver disease Vol. 52; no. 5; pp. 541 - 546
• Main Authors: Masarone, Mario, Caruso, Rosa, Aglitti, Andrea, Izzo, Carmine, De Matteis, Giuseppe, Attianese, Maria Rosaria, Pagano, Antonio Maria, Persico, Marcello
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2020
• Subjects: Adult; Aged; Antiviral Agents - therapeutic use; Direct antiviral agents; Female; HCV infection; Hepacivirus - genetics; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C Antibodies - analysis; Humans; Italy - epidemiology; Lost to Follow-Up; Male; Middle Aged; People in conviction; Point-of-care screening and treatment; Point-of-Care Systems; Prevalence; Prisons; Prospective Studies; Refusal to Treat - statistics & numerical data; Sustained Virologic Response; Sustained virological response; Young Adult; Italy; Point-of-care screening and treatment; People in conviction; Sustained virological response; HCV infection; Direct antiviral agents
• ISSN: 1590-8658; 1878-3562; 1878-3562
• DOI: 10.1016/j.dld.2020.02.012

An unmet objective in the pursuit of HCV elimination is the creation of a simple and fast operating model to identify difficult-to-treat populations, like prisoners. Of many obstacles, the first is represented by the poor knowledge of inmates HCV-Ab prevalence. Moreover, due to the peculiar status of conviction, often their access to antiviral therapy is neglected. To evaluate the prevalence of HCV infection in a penitentiary Institution of Southern Italy through a point-of-care screening and treatment program. We conducted a prospective observational study in two phases: first, we reviewed all the prisoners’ clinical records, to verify HCV-Ab execution. Subsequently, we performed a universal point-of-care screening and treatment program. We enrolled 670 patients. Overall, 310(46.27%) were already HCV-Ab tested. At the screening initiation, 23.28% patients were discharged, whereas 8.35% refused. Of the remaining 458 subjects, 58(12.67%) were HCV-Ab positive and 46 HCVRNA positive. All these underwent DAA, obtaining 100% SVR. At the end of the program, a total of 491(73.28%) subjects had HCV-Ab available. Sixty-nine (14.05%) were positive. A total of 214(31.94%) subjects were lost to follow-up. We revealed a prevalence of 14.05% of HCV-Ab in conviction. Antiviral treatment was safe and efficacious. More efforts are advisable to provide screening for HCV-Ab in conviction.