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. 2021 Jul;27(3):474-485.
doi: 10.3350/cmh.2021.0015. Epub 2021 Feb 19.

The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients

Yu Jun Wong  1   2   3 , Prem Harichander Thurairajah  4 , Rahul Kumar  1   3 , Kwong Ming Fock  1   2   3 , Ngai Moh Law  1   2 , Sin-Yoong Chong  1 , Fria Gloriba Manejero  1 , Tiing-Leong Ang  1   2   3 , Eng Kiong Teo  1   2   3 , Jessica Tan  1
Affiliations

The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients

Yu Jun Wong et al. Clin Mol Hepatol. 2021 Jul.

Abstract

Background/aims: Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.

Methods: In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013-2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.

Results: A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).

Conclusion: In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.

Keywords: Antiviral agents; Hepatitis C, Chronic; Prisons.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Treatment outcomes during restricted DAA access era versus unrestricted DAA access era. SVR, sustained-virological response; ITT, intention-to-treat; PP, per-protocol; DAA, direct-acting antivirals. *P<0.05 between restricted DAA and unrestricted DAA era.
Figure 2.
Figure 2.
Exponential increase in non-cirrhotic hepatitis C virus patients treated following unrestricted access to direct-acting antivirals.
Figure 3.
Figure 3.
Treatment outcomes among incarcerated patients with liver cirrhosis. SVR, sustained-virological response; ITT, intention-to-treat; PP, per-protocol; DAA, direct-acting antivirals. *P<0.05 between restricted DAA and unrestricted DAA era.
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