Near-elimination of the hepatitis C virus in a prison population in North Queensland has occurred in less than two years since direct-acting antiviral (DAA) therapy became available on the PBS.
And it has been achieved without a controversial needle and syringe program (NSP).
According to a report in Clinical Infectious Diseases, HCV prevalence in Lotus Glen Correctional Centre fell from 12.6% in February 2016 to 4.3% in March 2017 and 1.1% by December 2017.
Dr Darren Russell, from the Cairns Sexual Health Service, told the limbic the program had been incredibly successful.
“It’s been a miracle really. It is so easy now and I think one of the problems that doctors have when they start to use these medications is they overthink them because the medicines were so horrible in the past. It’s not a lot more complicated than giving a long course of antibiotics.”
“We don’t routinely test the prisoners while they are on treatment; we test them 12 weeks following completion for a cure. We rarely see side effects or problems with these treatments so monitoring is absolutely minimal which is very different to the old days.”
All new inmates are offered HCV antibody screening then if necessary, confirmatory HCV RNA and HCV genotype testing. Other detainees are also tested if symptomatic or after self-identification of possible HCV exposure. Inmates with detectable HCV RNA are offered an interferon-free DAA regimen for 8, 12 or 24 weeks.
Of the 119 inmates who started treatment, all men with a median age of 34 years, 12% had cirrhosis. The most common genotype was 3a.
Dr Russell said concurrent work in the local community meant the numbers of new prisoners being admitted with hepatitis C was also dropping off.
“Because we have also been clearing the Cairns region of HCV, reinfection rates have stayed surprisingly low. So the job actually gets easier over time.”
“What will be tricky is sustaining the enthusiasm and the momentum when there is very little hepatitis C left to treat.”
Needle and syringe programs
Dr Russell said the controversial issue of needle and syringe programs in Australian prisons remained.
“There is certainly still a lot of advocacy for NSP in prisons and from a human rights perspective maybe that is very reasonable, but from the perspective of eradicating hep C, maybe it’s not necessary. You can do it without that.”
He said he was aware of other prisons in regional Queensland also doing ‘a fantastic job’ with hepatitis C treatment programs.
“Brisbane prisons are finding it difficult. There are a whole lot of system blocks that need to be overcome.”
Dr Sofia Bartlett, from the Viral Hepatitis Clinical Research Program at the Kirby Institute, told the limbic Victoria was the only state with a DAA treatment program rolled out across the entire corrections system.
“So there is DAA therapy available in all the facilities now with a nurse-led model of care but some restrictions with eligibility based on length of sentence.”
“At the moment if your sentence is less than 12 weeks, you are not eligible for treatment. And that is based on issues with retaining people in care and follow-up.”
Dr Bartlett said the key message was that providing a simple and effective treatment service was not difficult when it was taken to the people with HCV infection.
However she warned there was a still a role for needle and syringe programs in prisons especially for example, in urban NSW where HCV prevalence was more than 50%.
In New South Wales, the Compulsory Drug Treatment Correctional Centre has also reported eradication of HCV.