Timothy Papaluca1, Lucy McDonald1, Anne Craigie1, Annabelle Gibson1, Paul Desmond1, Darren Wong1, Rebecca Winter2, Nick Scott3, Jessica Howell4, Joseph Doyle5, Alisa Pedrana2, Andrew Lloyd6, Mark Stoove3, Margaret Hellard3, David Iser7, Alexander Thompson8. 1. Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia. 2. Burnet Institute, Melbourne, Australia. 3. Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Australia. 4. Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia; Burnet Institute, Melbourne, Australia. 5. Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne Australia. 6. Kirby Institute, University of New South Wales, Australia. 7. Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne Australia. 8. Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia. Electronic address: alexander.THOMPSON@svha.org.au.
Abstract
BACKGROUND & AIMS: Treatment programs for people who inject drugs (PWID), including prisoners, are important for achieving hepatitis C elimination targets. There are multiple barriers to treatment of hepatitis C in prisons, including access to specialist physicians, testing and antiviral therapy, short prison sentences, and frequent inter-prison transfer. We aimed to assess the effectiveness of a nurse-led model of care for the treatment of prisoners with hepatitis C. METHODS: A statewide program for assessment and management of hepatitis C was developed in Victoria, Australia to improve access to care for prisoners. This nurse-led model of care is supported by telemedicine to provide decentralized care within all prisons in the state. We prospectively evaluated the feasibility and efficacy of this nurse-led model of care for hepatitis C within the 14 adult prisons over a 13-month period. The primary endpoint was sustained virological response at post-treatment week 12 (SVR12) using per protocol analysis. RESULTS: There were 416 prisoners included in the analysis. The median age was 41 years, 90% were male, 50% had genotype 3 and 44% genotype 1 hepatitis C and 21% had cirrhosis. Injecting drug use was reported by 68% in the month prior to prison entry, 54% were receiving opioid substitution therapy, and 86% reported never previously engaging with specialist HCV care. Treatment duration was 8 weeks in 24%, 12 weeks in 59%, and 24 weeks in 17% of treatment courses. The SVR12 rate was 96% (301/313) per protocol. Inter-prison transfer occurred during 26% of treatment courses but was not associated with lower SVR12 rates. No treatment-related serious adverse events occurred. CONCLUSION: Hepatitis C treatment using a decentralized, nurse-led model of care is highly effective and can reach large numbers of prisoners. Large scale prison treatment programs should be considered to support hepatitis C elimination efforts. LAY SUMMARY: There is a high burden of hepatitis C infection among prisoners worldwide. Prisoners who continue to inject drugs are also at risk of developing new infections. For this reason, the prison setting provides an opportunity to treat those people at greatest risk of infection and to stop transmission to others. We developed a new method of providing hepatitis C treatment to prisoners, in which nurses rather than doctors assessed prisoners locally at each prison site. Treatment was safe and most prisoners were cured. Such programs will contribute greatly to achieving the World Health Organization's hepatitis C elimination goals. Crown
BACKGROUND & AIMS: Treatment programs for people who inject drugs (PWID), including prisoners, are important for achieving hepatitis C elimination targets. There are multiple barriers to treatment of hepatitis C in prisons, including access to specialist physicians, testing and antiviral therapy, short prison sentences, and frequent inter-prison transfer. We aimed to assess the effectiveness of a nurse-led model of care for the treatment of prisoners with hepatitis C. METHODS: A statewide program for assessment and management of hepatitis C was developed in Victoria, Australia to improve access to care for prisoners. This nurse-led model of care is supported by telemedicine to provide decentralized care within all prisons in the state. We prospectively evaluated the feasibility and efficacy of this nurse-led model of care for hepatitis C within the 14 adult prisons over a 13-month period. The primary endpoint was sustained virological response at post-treatment week 12 (SVR12) using per protocol analysis. RESULTS: There were 416 prisoners included in the analysis. The median age was 41 years, 90% were male, 50% had genotype 3 and 44% genotype 1 hepatitis C and 21% had cirrhosis. Injecting drug use was reported by 68% in the month prior to prison entry, 54% were receiving opioid substitution therapy, and 86% reported never previously engaging with specialist HCV care. Treatment duration was 8 weeks in 24%, 12 weeks in 59%, and 24 weeks in 17% of treatment courses. The SVR12 rate was 96% (301/313) per protocol. Inter-prison transfer occurred during 26% of treatment courses but was not associated with lower SVR12 rates. No treatment-related serious adverse events occurred. CONCLUSION:Hepatitis C treatment using a decentralized, nurse-led model of care is highly effective and can reach large numbers of prisoners. Large scale prison treatment programs should be considered to support hepatitis C elimination efforts. LAY SUMMARY: There is a high burden of hepatitis C infection among prisoners worldwide. Prisoners who continue to inject drugs are also at risk of developing new infections. For this reason, the prison setting provides an opportunity to treat those people at greatest risk of infection and to stop transmission to others. We developed a new method of providing hepatitis C treatment to prisoners, in which nurses rather than doctors assessed prisoners locally at each prison site. Treatment was safe and most prisoners were cured. Such programs will contribute greatly to achieving the World Health Organization's hepatitis C elimination goals. Crown
Authors: Nadine Kronfli; Camille Dussault; Sofia Bartlett; Dennaye Fuchs; Kelly Kaita; Kate Harland; Brandi Martin; Cindy Whitten-Nagle; Joseph Cox Journal: Can Liver J Date: 2021-08-09
Authors: Maria A Corcorran; Natasha Ludwig-Baron; Debbie M Cheng; Dmitry Lioznov; Natalia Gnatienko; Gregory Patts; Kaku So-Armah; Elena Blokhina; Sally Bendiks; Evgeny Krupitsky; Jeffrey H Samet; Judith I Tsui Journal: AIDS Behav Date: 2021-03-17
Authors: Timothy Papaluca; Anne Craigie; Lucy McDonald; Amy Edwards; Michael MacIsaac; Jacinta A Holmes; Matthew Jarman; Tanya Lee; Hannah Huang; Andrew Chan; Mark Lai; Vijaya Sundararajan; Joseph S Doyle; Margaret Hellard; Mark Stoove; Jessica Howell; Paul Desmond; David Iser; Alexander J Thompson Journal: PLoS One Date: 2020-11-18 Impact factor: 3.240