Prisons: The Problem and Solution of Hepatitis C?

The World Health Organization (WHO) set a target to eliminate hepatitis C by 2030, and one of the ways that can become a reality is by identifying commonly infected populations. Prisons are one place where the virus thrives.

Hepatitis C is curable; however, getting rid of the infection does not take away accompanying liver risks. In addition, many people who are infected don’t even know it — making eradication a distant, but possible, future. Peter Vickerman, BSc, DPhil, from Bristol University’s Division of Global Public Health, and colleagues from the University of New South Wales (UNSW) in Australia looked at a population in which transmission is common and learned some insightful lessons.

The World Health Organization (WHO) set a target to eliminate hepatitis C by 2030, and one of the ways that can become a reality is by identifying commonly infected populations. Prisons are one place where the virus thrives. As many as one in six inmates have hepatitis C in parts of the United States and Europe. It’s suspected that non-sterile injecting equipment is to blame for the high transmission rates.

“On the downside, it is clear that prisons act as incubators of hepatitis C, driving the epidemic both within the prison system and in the community at large,” Andrew Lloyd, MD, from the UNSW, said in a news release. “On the plus side, they also offer a unique environment to cure people of the disease and address the risk behavior that fuels transmission.”

Presented at the 5th International Symposium on Hepatitis Care in Substance Users (INSHU 2016) in Norway, the team analyzed hepatitis C transmission in prisons located in Scotland, Australia, Ukraine, and Thailand. One of the findings indicated that presenting prevention programs within the prisons, as well as to those who are being released back into the community, could significantly cut infections.

“If we can turn prisons around, and use them to treat hepatitis C rather than facilitate its spread, then we can save lives, reduce the overall burden of disease, and take concrete steps towards disease elimination,” Lloyd continued.

One challenge with hepatitis C rates is that screening and treatment for the infection are rarely made available to inmates, explained Jason Grebely, BSc, PhD, president of the International Network of Hepatitis C in Substance Users (INHSU) and associate professor at the Kirby Institute at UNSW. So even though prisoners are secluded, that’s only for a matter of time and transmission within prison walls poses a major public health concern.

“Scaling up harm reduction programs and introducing testing and treatment strategies could potentially reduce and even reverse hepatitis C transmission and help us reach the WHO elimination goals,” Grebely said. “If we are serious about treating this disease, we need to seize the opportunity prisons present and make testing, treatment and prevention in this setting a priority.”

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