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Stöver H, Meroueh F, Marco A, Keppler K, Saiz de la Hoya P, Littlewood R, Wright N, Nava F, Alam F, Walcher S, Somaini L. Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe. BMC Public Health 2019; 19:30. [PMID: 30621658 PMCID: PMC6323720 DOI: 10.1186/s12889-018-6357-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023] Open
Abstract
Background Prisoners have a high prevalence of hepatitis C virus (HCV) infection but may find it difficult to access healthcare services. This may be related to risk behaviour including history of injecting drugs and marginalisation related to problem drug use/ opioid use disorder (OUD). Direct-acting antiviral products with superior efficacy and safety compared to interferon-based regimens offer HCV cure. Many citizens in Europe have been treated, although few received therapy in prisons. Methods Analysis of prisoner HCV treatment need and policy determinants of clinical practice was completed for 5 EU countries. Evidence was collected from national statistical sources and peer-reviewed publications to describe prison populations and HCV prevalence, to map national prison/ HCV health policy or guidance. A consensus of important principles for prisoner HCV care was developed. Results Data from published sources describing prisoner HCV prevalence is limited. Prisoner population requiring HCV treatment is not known; estimated numbers based on analysis of evidence: England and Wales, 9000, France, 8000, Spain, 6000, Italy, 6000, Germany, 6000. Treatment access: national law defines right to equivalent care in all countries implying access to HCV therapy in prison similar to community; useful prisoner HCV guidance facilitating treatment decisions present in: 4 of 5 national/ regional HCV policy documents, 4 of 5 national prison healthcare policies. Four of five had practical prison HCV clinical guidelines. Despite existence of policy, implementation of guidance, and so HCV treatment, is suboptimal in many locations. Conclusions Prison is an important location to detect, address and treat HCV infection in people who may be underserved for healthcare and find it difficult to navigate community treatment pathways. This is often related to problems with OUD and resulting social inequity. HCV management in prisons must be improved. Policy and clinical practice guidance must be set to promote treatment, and practical steps to make treatment easy should be followed including education to promote engagement, set-up of optimal screening and work up processes with modern tools to reduce time needed/ achieve efficiency; programs to make it easier to get specialists’ input include remote working and nurse-led services.
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Affiliation(s)
- H Stöver
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany.
| | - F Meroueh
- Health Unit, Villeneuve les Maguelone, France
| | - A Marco
- Penitentiary Program, Catalan Health Institute, Barcelona, Spain
| | | | | | | | - N Wright
- Spectrum Community Health CIC, Wakefield, UK
| | - F Nava
- University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy
| | - F Alam
- Divisional Medical Director, Central and North West London NHS Foundation Trust, London, UK
| | - S Walcher
- CONCEPT, Addiction Medicine, Munich, Germany
| | - L Somaini
- Addiction Treatment Centre, Biella, Italy
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Ranieri R, Starnini G, Carbonara S, Pontali E, Leo G, Romano A, Panese S, Monarca R, Prestileo T, Barbarini G, Babudieri S. Management of HCV infection in the penitentiary setting in the direct-acting antivirals era: practical recommendations from an expert panel. Infection 2016; 45:131-138. [PMID: 28025726 DOI: 10.1007/s15010-016-0973-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/06/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of HCV infection is higher among prisoners than in the general population. The introduction of HCV direct-acting antivirals (DAA) holds the potential to improve clinical outcomes also in inmates. However, treatment of hepatitis C in inmates has to face several clinical and logistical issues which are peculiar of prison environment. Recommendations on the management of HCV infection specific for the penitentiary setting in the DAA era remain scant. The Italian Society for Penitentiary Medicine and Healthcare has, therefore, issued these recommendations, to provide clinicians with a guide for the comprehensive management of HCV infection in the restriction setting, taking into account its peculiar characteristics. RESULTS Dedicated diagnostic and treatment procedures should be established in each prison. In particular, the use of DAAs appears crucial to provide patients with an effective therapeutic option, able to overcome the limitations of IFN-based regimens with a short period of treatment. DAA treatment should be initiated as soon as possible in all eligible subjects with the aim to cure the patient, as well as to limit the transmission of HCV infection both inside the penitentiary system and to the free community, once the inmates ends his/her release. Importantly, efforts should be made to open a discussion with regulatory bodies, to define specific regulations aimed to guarantee wide access to effective therapies of all eligible patients, to optimize the management of and the adherence to the HCV treatment, and to ensure the therapeutic continuity after discharge from prison.
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Affiliation(s)
- Roberto Ranieri
- Azienda Ospedaliera Santi Paolo e Carlo Penitentiary Infectious Diseases Unit, University of Milan, Milan, Italy
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
| | - Giulio Starnini
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- U.O.C. Medicina protetta-Malattie infettive, Viterbo, Italy
| | - Sergio Carbonara
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Emanuele Pontali
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Infectious Disease Unit, Ospedale Galliera, Genoa, Italy
| | - Guido Leo
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Infectious Disease Unit, Ospedale Amedeo di Savoia, Turin, Italy
| | | | - Sandro Panese
- Ospedale dell'Angelo Malattie infettive e Tropicali, Venice, Italy
| | - Roberto Monarca
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Ospedale Belcolle, Viterbo, Italy
| | | | - Giorgio Barbarini
- Malattie Infettive e Tropicali IRCCS San Matteo, Università di Pavia, Pavia, Italy
- Case Circondariali di Pavia, Voghera e Vigevano, Italy
| | - Sergio Babudieri
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.
- Infectious Disease Unit, University of Sassari, Sassari, Italy.
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