Background: HCV infection among vulnerable populations is currently a major issue for HCV elimination program. Incarcerated people and people who inject drugs (PWIDs) are key population groups potentially at high risk for HCV infection. Our aim was to evaluate an extended program of screening, staging and treatment in Italian prison settings. Methods: Patients from eight prisons in five different Italian Regions were enrolled. HCV saliva test (QuickOral Test®) was offered. Data on infection awareness and illicit drug use were also collected. Positive patients underwent early HCV RNA evaluation, staging and prescription on DAAs treatment. The definition of PWID was based on self-reported injecting drug use extracted from medical records (injecting drug use during the previous six months). Results: A total of 2,376 out of 2,687 individuals (88%) was tested. The median (IQR) age was 42 (32–50) years. PWIDs were 537out of 2,376 (23%). Prevalence of HCV antibodies was 10.4% (248/2,376). PWIDs had a lower awareness of their HCV-Ab positivity than non-PWIDs (p-value <0.001). Furthermore, PWIDs were less likely to be previously treated than non-PWIDs (78% vs 96%, p-value= 0.017). Active infection was found in 41% of patients (101/248). Overall, 61% HCV-positive were PWIDs, with 44% HCV RNA positive. HCV therapy was prescribed to 83% (84/101) of patients with active HCV infection and 67% of these (56/84) were PWIDs. Prescription for HCV treatment in PWIDs accounted for 84% (56/67) (while for non-PWIDs was 82% (28/34) p-value: 0.88. Seventeen patients were referred to a Specialist in other prisons because they were going to be transferred soon to another prison. EOT, as well as SVR12 were achieved in 98% (82/84) treated patients. Conclusions: Among patients, PWIDs had a lower awareness of their HCV-Ab positivity and had previously received less treatments. Saliva test allowed to achieve a more rapid result, stage, and treatment approach. More than 80% of patients underwent treatment, without differences between PWIDs and non-PWIDs. Linkage to care during prison transfer allowed to avoid unplanned interruptions and offered more chances to reach the end of treatment

HCV testing and treatment initiation in an Italian prison setting: A step-by-step model to micro-eliminate hepatitis C / Fiore, Vito; De Matteis, Giuseppe; Ranieri, Roberto; Saderi, Laura; Pontali, Emanuele; Muredda, Alberto; Ialungo, Anna Maria; Caruso, Rosa; Madeddu, Giordano; Sotgiu, Giovanni; Babudieri, Sergio. - In: THE INTERNATIONAL JOURNAL ON DRUG POLICY. - ISSN 0955-3959. - 90:(2020), p. 103055. [10.1016/j.drugpo.2020.103055]

HCV testing and treatment initiation in an Italian prison setting: A step-by-step model to micro-eliminate hepatitis C

Fiore, Vito;Saderi, Laura;Madeddu, Giordano;Sotgiu, Giovanni;Babudieri, Sergio
2020-01-01

Abstract

Background: HCV infection among vulnerable populations is currently a major issue for HCV elimination program. Incarcerated people and people who inject drugs (PWIDs) are key population groups potentially at high risk for HCV infection. Our aim was to evaluate an extended program of screening, staging and treatment in Italian prison settings. Methods: Patients from eight prisons in five different Italian Regions were enrolled. HCV saliva test (QuickOral Test®) was offered. Data on infection awareness and illicit drug use were also collected. Positive patients underwent early HCV RNA evaluation, staging and prescription on DAAs treatment. The definition of PWID was based on self-reported injecting drug use extracted from medical records (injecting drug use during the previous six months). Results: A total of 2,376 out of 2,687 individuals (88%) was tested. The median (IQR) age was 42 (32–50) years. PWIDs were 537out of 2,376 (23%). Prevalence of HCV antibodies was 10.4% (248/2,376). PWIDs had a lower awareness of their HCV-Ab positivity than non-PWIDs (p-value <0.001). Furthermore, PWIDs were less likely to be previously treated than non-PWIDs (78% vs 96%, p-value= 0.017). Active infection was found in 41% of patients (101/248). Overall, 61% HCV-positive were PWIDs, with 44% HCV RNA positive. HCV therapy was prescribed to 83% (84/101) of patients with active HCV infection and 67% of these (56/84) were PWIDs. Prescription for HCV treatment in PWIDs accounted for 84% (56/67) (while for non-PWIDs was 82% (28/34) p-value: 0.88. Seventeen patients were referred to a Specialist in other prisons because they were going to be transferred soon to another prison. EOT, as well as SVR12 were achieved in 98% (82/84) treated patients. Conclusions: Among patients, PWIDs had a lower awareness of their HCV-Ab positivity and had previously received less treatments. Saliva test allowed to achieve a more rapid result, stage, and treatment approach. More than 80% of patients underwent treatment, without differences between PWIDs and non-PWIDs. Linkage to care during prison transfer allowed to avoid unplanned interruptions and offered more chances to reach the end of treatment
HCV testing and treatment initiation in an Italian prison setting: A step-by-step model to micro-eliminate hepatitis C / Fiore, Vito; De Matteis, Giuseppe; Ranieri, Roberto; Saderi, Laura; Pontali, Emanuele; Muredda, Alberto; Ialungo, Anna Maria; Caruso, Rosa; Madeddu, Giordano; Sotgiu, Giovanni; Babudieri, Sergio. - In: THE INTERNATIONAL JOURNAL ON DRUG POLICY. - ISSN 0955-3959. - 90:(2020), p. 103055. [10.1016/j.drugpo.2020.103055]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/240295
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