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.


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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. 

Reference

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