Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine

Morey, Sarah, Hamoodi, Abi, Jones, Dee, Young, Tina, Thompson, Craig, Dhuny, Julie, Buchanan, Emma, Miller, Carolyn, Hewett, Margaret, Valappil, Manoj, Hunter, Ewan and McPherson, Stuart (2019) Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine. Journal of Viral Hepatitis, 26 (1). pp. 101-108. ISSN 1352-0504

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Abstract

With recent advances in anti‐viral therapy there is an opportunity to eliminate HCV from the UK population. HCV is common in incarcerated individuals, with previous estimates suggesting ~7% of the UK prison population is anti‐HCV antibody positive. Increasing diagnosis and treatment of HCV in prison is a priority in seeking to eliminate transmission in the general population. Thus the study aimed, to assess the impact implementation of: 1. A universal offer of blood borne virus testing (UOBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; 2. Telemedicine clinics (TC) within North East England (NEE) prisons to increase HCV treatment rates. UOBBVT was initially implemented at Her Majesty's Prison (HMP) Durham, commencing March 2016. From March 2016 to February 2017, 2,831 of 4,280 (66%) new receptions were offered BBV testing. Of these, 1,495 (53% of offered) accepted BBV testing, of whom 95 (6.4%) were HCV antibody positive, with 47 of those 95 (49.5%) HCV RNA positive, suggesting a prevalence of active infection in the tested population of 3.1% (95% CI 2.4% to 4.2%). Between August 2015 and October 2017, 80 individuals were seen in the TC and 57 (71%) commenced antiviral therapy. Of those with known outcome (n=29), 100% achieved sustained virological response. In the year prior to implementation, only 4 patients received HCV treatment. In conclusion, a universal offer of BBV testing to inmates presenting at HMP reception coupled with linkage into specialist care via TC can substantially increase rates of testing, diagnosis and treatment of HCV in this high prevalence population.

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