People with chronic HCV treatment miss out on treatment after prison

Only a minority of people released from prison with untreated hepatitis C are capable of accessing antiviral treatment in the community despite referral to a healthcare service near their intended residence, research shows.

In a study of 75 people assessed as HCV RNA positive in Victorian prisons but released without treatment – usually due to a short sentence duration – only 12 received antivirals in the community within the next six months.

Dr Tim Papaluca, a hepatology fellow at St Vincent’s Hospital Melbourne, told AGW 2019 that almost as many people – 7 of the 75 – only received treatment when they were re-incarcerated.

The study group were mostly men aged 40 years and about 15% had cirrhosis. Most identified as people who inject drugs and most also reported a psychiatric illness.

The re-incarceration rate was 21%.

Dr Papaluca said the data highlighted that current models of care in the community were not particularly successful.

“They’re low numbers and some people are getting to treatment but from what we know about our experience with a prison-based population, more than 80% have never even engaged with hepatitis C care while they are in the community,” he said.

“12 out of 75 did get to treatment but it would be great if it was 75 of 75. When people come out of prison there are so many things going on in their lives that naturally and expectedly, hepatitis C drops down the list.”

“They are obviously a population that do find traditional models of care difficult to engage with.”

He said one possible solution was for more rapid testing and initiation of treatment in prison.

And the value of more dynamic models of care in the community, such as including follow-up phone calls and incentives for reaching treatment goals, was currently being tested.

“People don’t necessarily end up where they think they are going to go and so contacting them over the phone and trying to facilitate getting them onto care is helpful.”

“As part of the prospective study we are doing now, once people are into the community we are asking them a lot of questions around living status, income status, recidivism status, etcetera to try and work out what are the barriers to getting on care for some people.”

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