HCV treatment as prevention in prison: Key issues

Hepatology ◽  
2014 ◽  
Vol 61 (1) ◽  
pp. 402-403 ◽  
Author(s):  
Natasha K. Martin ◽  
Peter Vickerman ◽  
David Goldberg ◽  
Matthew Hickman
Keyword(s):  
Treatment As Prevention ◽  
Hcv Treatment ◽  
Key Issues

scholarly journals Considering treatment-as-prevention scale-up for Australian prisons: a qualitative sub-study of expert stakeholders from the Australian ‘surveillance and treatment of prisoners with hepatitis C’ project (SToP-C)

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jake Rance ◽  
◽  
Lise Lafferty ◽  
Carla Treloar
Keyword(s):  
Hepatitis C ◽  
Primary Prevention ◽  
Critical Role ◽  
Scale Up ◽  
Treatment As Prevention ◽  
Structured Interviews ◽  
Hcv Treatment ◽  
Public Health Response ◽  
Direct Acting ◽  
Levels Of Support

Abstract Background With direct-acting antivirals dramatically reshaping the public health response to the hepatitis C virus (HCV), prisons are set to play a critical role in elimination efforts. Despite the theoretical demonstration of HCV treatment-as-prevention in prison in mathematical modeling, limited empirical data exist. The Australian ‘Surveillance and Treatment of Prisoners with Hepatitis C’ project (SToP-C) is the world’s first trial of HCV treatment-as-prevention in prison. Drawing on interviews with HCV expert stakeholders, this paper explores the factors respondents identified as crucial to the success of future scale-up. Accounting for such perspectives matters because of the influence expert discourse has in shaping implementation. Methods Semi-structured interviews were conducted with nineteen HCV experts working across key policy, advocacy, research and clinical dimensions of the Australian HCV response. Data were coded using qualitative data management software (NVivo 11). Analysis proceeded via a hybrid deductive and inductive approach. Results Notwithstanding concerns regarding the lack of primary prevention in Australian prisons, stakeholders reported broad levels of support for the intervention and for the future scale-up of HCV treatment. A number of considerations, both external and internal to the prison system, were identified as key. The principal external factor was an enabling political-cum-policy environment; internal factors included: obtaining support from prisons’ executive and custodial staff; promoting health within a security-first institutional culture; allocating time for treatment within prisoners’ tightly regulated schedules; ensuring institutional stability during treatment given the routine movement of prisoners between prisons; prioritizing the availability of retreatment given the paucity of primary prevention; and securing sufficient clinical space for treatment. Conclusion The challenges to implementation are considerable, ranging from macrolevel concerns to in-prison logistical matters. Nonetheless, we argue that prisons remain an obvious setting for treatment scale-up, not only for prevention and potential elimination benefit, but for the treatment opportunities they afford a socially disadvantaged and underserved population. While noting widespread concerns among respondents regarding the paucity of primary prevention in Australian prisons, results indicate broad levels of support among expert stakeholders for HCV treatment scale-up in prison.

scholarly journals Treatment as prevention for hepatitis C virus in Pakistan: mathematical modelling projections

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026600 ◽  
Author(s):  
Houssein H Ayoub ◽  
Laith J Abu-Raddad
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Incidence Rate ◽  
Treatment As Prevention ◽  
Treatment Programme ◽  
Annual Incidence Rate ◽  
Rate Reduction ◽  
Hcv Treatment ◽  
Age Structured ◽  
Direct Acting

ObjectiveDirect-acting antivirals have opened an opportunity for controlling hepatitis C virus (HCV) infection in Pakistan, where 10% of the global infection burden is found. We aimed to evaluate the implications of five treatment programme scenarios for HCV treatment as prevention (HCV-TasP) in Pakistan.DesignAn age-structured mathematical model was used to evaluate programme impact using epidemiological and programme indicators.SettingTotal Pakistan population.ParticipantsTotal Pakistan HCV-infected population.InterventionsHCV treatment programme scenarios from 2018 up to 2030.ResultsBy 2030 across the five HCV-TasP scenarios, 0.6–7.3 million treatments were administered, treatment coverage reached between 3.7% and 98.7%, prevalence of chronic infection reached 2.4%–0.03%, incidence reduction ranged between 41% and 99%, program-attributed reduction in incidence rate ranged between 7.2% and 98.5% and number of averted infections ranged between 126 221 and 750 547. Annual incidence rate reduction in the first decade of the programme was around 6%–18%. Number of treatments needed to prevent one new infection ranged between 4.7–9.8, at a drug cost of about US$900. Cost of the programme by 2030, in the most ambitious elimination scenario, reached US$708 million. Stipulated WHO target for 2030 cannot be accomplished without scaling up treatment to 490 000 per year, and maintaining it for a decade.ConclusionHCV-TasP is a highly impactful and potent approach to control Pakistan’s HCV epidemic and achieve elimination by 2030.

scholarly journals Evaluating the prevention benefit of HCV treatment: Modelling the SToP‐C treatment as prevention study in prisons

Hepatology ◽  
2021 ◽  
Author(s):  
Aaron G. Lim ◽  
Jack Stone ◽  
Behzad Hajarizadeh ◽  
Marianne Byrne ◽  
Georgina M. Chambers ◽  
...  
Keyword(s):  
Treatment As Prevention ◽  
Prevention Study ◽  
Hcv Treatment ◽  
Prevention Benefit

scholarly journals Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) – a natural experiment (protocol)

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029538 ◽  
Author(s):  
Matthew Hickman ◽  
John F Dillon ◽  
Lawrie Elliott ◽  
Daniela De Angelis ◽  
Peter Vickerman ◽  
...  
Keyword(s):  
Drug Treatment ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Treatment As Prevention ◽  
Hcv Treatment ◽  
Direct Acting Antiviral ◽  
Link Type ◽  
Hcv Prevalence ◽  
Chronic Hcv ◽  
Direct Acting

IntroductionHepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV ‘Treatment as Prevention’ (TasP) in PWID.Methods and analysisWe plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome – chronic HCV prevalence in PWID – is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a ‘virtual cohort’ of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes.Ethics and disseminationExtending HCV community care pathways is covered by ethics (ERADICATE C,ISRCTN27564683, Super DOT C Trial clinicaltrials.gov:NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.

scholarly journals Behavioural, not biological, factors drive the HCV epidemic among HIV-positive MSM: HCV and HIV modelling analysis including HCV treatment-as-prevention impact

2017 ◽  
Vol 46 (5) ◽  
pp. 1582-1592 ◽  
Author(s):  
Louis MacGregor ◽  
Natasha K Martin ◽  
Christinah Mukandavire ◽  
Ford Hickson ◽  
Peter Weatherburn ◽  
...  
Keyword(s):  
Hiv Positive ◽  
Treatment As Prevention ◽  
Biological Factors ◽  
Hcv Treatment ◽  
Modelling Analysis

P0801 : Eradicate HCV: Treatment as prevention in chaotic drug users

2015 ◽  
Vol 62 ◽  
pp. S634
Author(s):  
F. Ahmad ◽  
L. Johnston ◽  
B. Stephens ◽  
J. Dillon
Keyword(s):  
Drug Users ◽  
Treatment As Prevention ◽  
Hcv Treatment

Declining HCV incidence following rapid HCV treatment scale-up in a prison network in Australia: Evidence of treatment as prevention from the SToP-C study

2020 ◽  
Vol 73 ◽  
pp. S127
Author(s):  
Gregory Dore ◽  
Behzad Hajarizadeh ◽  
Jason Grebely ◽  
Marianne Byrne ◽  
Pip Marks ◽  
...  
Keyword(s):  
Scale Up ◽  
Treatment As Prevention ◽  
Hcv Treatment
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