PRISONS COULD UNLOCK HEPATITIS C FREE FUTURE
Treatment in prisons a public health priority, says new research
(Thursday,
8 September 2016: Oslo) Prisons provide one of the most significant opportunities to drive down
the prevalence of hepatitis C, and help reach global WHO elimination goals,
says new research presented at the 5th
International Symposium on Hepatitis Care in Substance Users today.
“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,” said Professor Andrew Lloyd of the
University of New South Wales in Australia who leads hepatitis research in the
prison system in that country.
“On the
plus side, they also offer a unique environment to cure people of the disease
and address the risk behaviour that fuels transmission. 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.”
Hepatitis C - virus which if left untreated can lead to cirrhosis
and liver cancer - affects approximately 64-103 million people around the
world, resulting in around 700 000 deaths per year. The World Health
Organisation (WHO) has prioritised the disease, setting ambitious targets to
reach elimination by 2030.
In
high income countries 80% of new infections are in people who use drugs. Prisoners have a particularly high
prevalence of hepatitis C with as many as 1 in 6 inmates carrying the
disease in parts of Europe and the US, reflecting the
fact that imprisonment and injecting drug use are closely linked. This high
prevalence means that use of non-sterile injecting equipment whilst in prison
carries a high risk of transmission.
A new modelling analysis - presented at INHSU
2016 and led by Professor Peter Vickerman at Bristol University’s Division of
Global Public Health - looked at hepatitis C transmission in
scenarios mimicking four global settings: Scotland, Australia, Ukraine and
Thailand. It found that prison could contribute massively to overall HCV
transmission, whereas introducing prevention programs in prison and
amongst individuals transitioning back to the community could significantly
reduce these infections. The study is published as part of a recent Lancet-commissioned report on drugs and
health.
Additional modelling studies in the UK have also shown that
treatment with new highly effective therapies could also have a substantial
impact, and could be cost-effective if continuity of care is ensured.
“It is clear from our modelling that incarceration is a very
important driver of HCV transmission in many settings.
It is unlikely that it will be controlled without focusing prevention
and control measures on incarcerated individuals and those being released from
prison,” said Professor Vickerman.
So far, Australia is one of the only countries
to look at the mass scale up of new hepatitis C treatment combined with
prevention programs in a prison setting. Health experts at INHSU 2016 say
the evidence indicates it is now time for other countries to follow their lead.
“The high level of
mobility between prison and the community means that the health of prisoners
should be a major public-health concern,” said President of the International Network
of Hepatitis C in Substance Users (INHSU), Associate Professor Jason Grebely,
the Kirby Institute, UNSW Australia.
“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. Yet, screening and
treatment for hepatitis C is rarely made available to inmates.
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.”
ABOUT INHSU 2016
This symposium is the leading international
conference focused on the management of hepatitis among substance users. It is
organised by the International Network for Hepatitis in Substance Users
(INHSU). The symposium is held biennially and was first held in Zurich,
Switzerland, in 2009, Brussels, Belgium, in 2011, Munich, Germany, in 2013 and
Sydney, Australia, in 2015.
INHSU 2016: NEW RESEARCH
ON THE MANAGEMENT OFHEPATITIS C IN PRISONS
Absence of NSPs in prisons makes HCV
prevention difficult
https://www.eiseverywhere.com/file_uploads/4d9ee2dfb05265125c339559eb53a86c_030_CarlaTreloar.pdf
Incarceration may contribute
substantially to HCV transmission among PWID
https://www.eiseverywhere.com/file_uploads/54b51b48d0c8ebc98a7ce55749276b42_045_JackStone.pdf
High HCV incidence is observed in
Australian prisons
https://www.eiseverywhere.com/file_uploads/022d5ebfaca7b1e19db6621fadf6ec1d_041_EvanCunningham.pdf
Risk behaviours for HCV acquisition in
the prison are high
https://www.eiseverywhere.com/file_uploads/8dfbcfa7c3c9aefea1b6b887315587f2_060_BehzadHajari.pdf