Prospective evaluation of the impact of repeated whole prison testing for hepatitis C

Abstract

Introduction: Chronic hepatitis C virus (HCV) infection is prevalent in prisons. Universal reception HCV testing is recommended, but acceptance can be suboptimal. To detect and treat missed HCV infections, a high-intensity test and treat (HITT) programme was introduced to rapidly test entire prisons. It remains unknown whether regular HITTs will be required to maintain prison microelimination. We aimed to assess the outcomes of HITTs conducted in a prison 4 years apart with ongoing reception testing.

Methods: A prospective observational evaluation of the impact of HITTs was conducted in January 2020 and February 2024 at Low Newton, a female prison. The outcomes of the reception testing were reviewed in the intervening period to determine the number of newly identified HCV infections.

Results: HITTs were successful in testing almost all residents (305/307) in 2020 and (296/296) in 2024. The number of newly diagnosed HCV individuals fell from 6.6% in 2020 to 0.3% in 2024. One new HCV case was identified in the second HITT. In between the HITTs, 89% of receptions had HCV testing, increasing from 83% in 2020 to 95% in 2023. Overall, 81% (144/178) of active HCV infections received antiviral treatment, and 89% achieved sustained virological response. The proportion of active HCV infections between the HITTs was 7.2% through reception testing.

Conclusion: A follow-up HITT after 4 years yielded only 0.3% active HCV infection in a high HCV prevalence prison and a reasonably good reception testing and treatment programme. Therefore, resources should be focused on optimising reception testing rather than undertaking repeated HITTs.

Keywords: ANTIVIRAL THERAPY; HEALTH SERVICE RESEARCH; HEPATITIS C.

Figure 1. Outcome of hepatits C virus RNA-positive patients between high-intensity test and treat events.

Figure 2. Outcome of HITT second event in His Majesty’s Prison Low Newton. Ab, antibody; HCV, hepatits C virus; HITT, high-intensity testing.

Figure 3. Summary of HCV testing outcome during and between HITT events in His Majesty’s Prison Low Newton. HCV, hepatitis C virus; HITT, high-intensity test and treat; SVR, sustained virological response.