Novel approaches to hepatitis eradication at prison centres

Who?

A close collaboration between El Dueso penitentiary centre (Cantabria, Spain) and the Marques de Valdecilla University Hospital.

Why?

HCV remains a major public health issue in Mediterranean countries like Spain. In Spanish prison settings, HCV prevalence is estimated at 22.7% (i.e., 10 times more than in the general population) and there is a significant risk of HCV transmission. Although micro-elimination strategies targeting inmates have been promising, they are often hampered by administrative barriers, inmates’ limited access to hepatitis services, reinfection, etc. Against this background, this project aimed to test the feasibility of sustained test and treat strategies and offer lessons to facilitate further deployment in prison settings.

How?

The project was divided into five phases to overcome implementation barriers and foster sustainability:

1. A multidisciplinary professional network was created under the coordination of a team of hepatologists, supported by a telemedicine expert. Administrative permissions were requested, and the telemedicine programme was set up;
2. Inmates were recruited and voluntary HCV screening was performed;
3. HCV infection characterisation was carried out;
4. Every infected inmate expected to stay in El Dueso over 30 days was offered treatment. To ensure care retention, oral therapy was delivered under the supervision of the prison healthcare staff comprising nurses, doctors and pharmacists. For those patients who spent some time outside prison, a pill counter and a direct interview were established for assessing compliance;
5. teleconsultation programme between the prison and hospital was established to follow up on patients and to monitor therapy. A video collaboration tool, available to all public administrations in Spain (‘Reúnete-Red SARA’), allowed for inmates and physicians to meet regularly, and for reinfections to be detected and quickly linked to care.

In addition, inmates who served their sentence could continue their follow-up care at the Marques de Valdecilla Hospital; whereas those transferred to other prisons were managed thanks to the information provided by the El Dueso’s healthcare staff.

Outcomes

Carried out between May 2016 and July 2017 in the El Dueso penitentiary centre, 847 inmates out of the 851 (99.5%) participated in the project. All participants were Caucasian with a median age of 36 years and 96% were male. 8% were active drug users and 7% were receiving opioid substitution therapy. Out of the 847 enrolled, 110 tested positive for HCV (13%). 69 of them were to stay in El Dueso more than 30 days and all agreed to initiate treatment. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were rescued with a salvage therapy after treatment failure, and only two were lost to follow up. By the end of the project, 409 inmates were in El Dueso and none had HCV, nor were any new infections registered, hence achieving a zero percent prevalence and incidence rate. All patients undergoing therapy used the telemedicine tool and reported high levels of satisfaction.

FUNDING

Private funding.