Hepatitis C Treatment-As-Prevention Reduces Virus Incidence In a Prison Setting

hepatitis c
Investigators assessed the effectiveness of hepatitis C virus treatment-as-prevention in a prison setting.

In a study on the effectiveness of hepatis C virus (HCV) treatment-as-prevention, direct-acting antiviral treatment was associated with reduced incidence of HCV. These study results were published in The Lancet Gastroenterology & Hepatology.

The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study was a prospective study within a cohort of people incarcerated at 2 facilities in Australia (ClinicalTrials.gov identifier: NCT02064049). Participants were divided into 3 subpopulations: uninfected (HCV antibody-negative), previously infected (HCV antibody-positive, HCV RNA-negative), and infected (HCV antibody and HCV RNA-positive). Follow-up to detect infection or reinfection was performed every 3 to 6 months. Direct-acting antiviral treatment was scaled up during the study period and incidence of HCV before and after scale-up was assessed.

Among the 3691 participants enrolled in the study, 719 (19%) had detectable HCV RNA, 2240 (61%) were at risk of primary HCV infection, and 725 (20%) were at risk of reinfection at baseline. During the treatment scale-up period, 349 of 499 (70%) eligible participants began treatment and HCV incidence analysis included 1643 participants at risk of infection or reinfection.

The incidence of HCV, primary infection, and reinfection all decreased from the pretreatment scale-up period to post-treatment scale-up period from 8.31 to 4.35 per 100 person-years (incidence rate ratio [IRR], 0.52; 95% CI, 0.36–0.78; P =.0007), 6.64 to 2.85 per 100 person-years (IRR, 0.43; 95% CI, 0.25–0.74; P =.0019) and 12.36 to 7.27 per 100 person-years (IRR, 0.59; 95% CI, 0.35-1.00; P =.05), respectively.

Injection drug-use while in prison was reported by 487 of 1643 (30%) participants. Among these participants, the incidence of primary infection and reinfection decreased from pretreatment to post-treatment scale-up, from 39.08 to 14.03 per 100 person-years (IRR, 0.36; 95% CI, 0.16–0.80; P =.0091) and 15.26 to 9.34 per 100 person-years (IRR, 0.61; 95% CI, 0.34–1.09; P =.093), respectively.

In an analysis adjusted for age, Indigenous Australian ethnicity, duration of stay in prison, previous imprisonment, injection drug-use status, and prison site, significant reductions in the risk of HCV infection was also observed (adjusted hazard ratio, 0.50; 95% CI, 0.33–0.76; P =.0014).

Study limitations included its design as a before-and-after evaluation rather than a randomized controlled trial. Additionally, HCV risk status was not evaluated for unenrolled people incarcerated at the 2 facilities and the rates of participant transfer and release were higher than expected. Finally, there was a low relative enrollment of women in the study cohort.

According to researchers, “The findings of the SToP-C study highlight both the feasibility and the positive effect of scaling up [direct-acting antiviral] treatment in reducing the incidence of HCV infection in the prison setting.” The demonstrated effectiveness should encourage better access to direct-acting antiviral treatment and rapid scale-up of treatment uptake, which in combination with efficient HCV diagnosis could have an even greater effect on transmission rates.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Hajarizadeh B, Grebely J, Byrne M, et al. Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study. Lancet Gastroenterol Hepatol. Published online May 6, 2021. doi: 10.1016/S2468-1253(21)00077-7