Treating prison inmates for hepatitis C infection is a key to ending the spread of the disease. A UK study found treatment works best when it can be completed before a prisoner is released or transferred.
Prisoners being treated for hepatitis C virus (HCV) often have similar outcomes to those being treated in the community setting, according to a recent study conducted in Scotland. But treatment is most effective when completed while the prisoner is still in the facility where treatment was started.
Published in the Journal of Viral Hepatitis and conducted by Esther Aspinall, MD, fo the School of Health and Life Sciences at Glasgow Caledonian University, and colleagues, the study compared treatment outcomes between HCV patients treated in prison and those treated in community-based programs and examined how treatment was impacted if prisoners were released during therapy.
Although directly-acting antiviral (DAA) therapies have shortened treatment times for HCV patients, the authors report “Nearly half of all prison sentences in Scotland are less than six months, providing limited time for HCV testing, assessment, and treatment completion, even in the DAA era.”
The researchers used a national database to compare treatment outcomes between prison treatment initiates and a matched community sample.
There were 2,657 patients included in the study, with 291 who initiated treatment in prison, and 2,366 who began treatment in the community.
Sixty-one percent patients who began treatment in prison achieved a sustained virologic response (SVR), compared to 63% of those who initiated treatment in the community. The researchers say, “The odds of achieving a SVR were not significantly associated with prisoner status at treatment initiation, whether calculated using conditional logistic regression or unmatched logistic regression.”
The second part of the study, in which the researchers collected additional data regarding how release or transfer impacted HCV therapy, showed a stark difference. “SVRs were 74% for those not released or transferred,” say the authors, “59% for those transferred, and 45% for those released during treatment.”
The authors acknowledge that HCV treatment in prison presents challenges, particularly when prisoners are transferred or released, but conclude, “This study has demonstrated that prison-based treatment is feasible, and achieves comparable or in some cases even better outcomes than community-based treatment.”