Title:Solving the Gap Between HCV Detection and Treatment in Prison HCVRNA
Testing and Treatment in a Cohort of Newly Arrived Convicts in
Southern Italy
Volume: 16
Issue: 4
Author(s): Carmine Izzo*, Mario Masarone, Pietro Torre , Giuseppe Melara , Giuseppe De Matteis , Antonio De Luna, Antonio Maria Pagano and Marcello Persico *
Affiliation:
- Internal Medicine and Hepatology Division, Department of Medicine and Surgery Scuola Medica Salernitana , Salerno,Italy
- Internal Medicine and Hepatology Division, Department of Medicine and Surgery Scuola Medica Salernitana , Salerno, Italy
Keywords:
Direct antiviral agents, HCV infection, people in conviction, point-of-care, HCV treatment, sustained virologicalresponse.
Abstract: Introduction: HCV infection elimination is set to be carried out by 2030. To achieve
this goal, the WHO has set minor achievable short-term “mini-goals.” One of these is treating “difficult
to reach and treat populations,” such as prisoners. One of the biggest obstacles to achieving
this mini goal is the poor knowledge of the real HCV prevalence in such a population and the barriers
to its detection, treatment, and follow-up. Even if HCV testing in Italian prisons is feasible and
recommended, it is not however always carried out. To worsen the picture, the peculiar status of
conviction is correlated to difficulty in caring out the antiviral therapy due to loss in follow-up and
to the refusals by inmates.
Aims: A point-of-care test-and-treat program was set up in a penitentiary in Southern Italy to reduce
the number of patients Lost To Follow-Up (LTFU) between detection and treatment. A secondary
aim was to evaluate the prevalence of HCV-infected patients in a cohort of newly arrived
inmates.
Methods: This prospective-observational study was carried out from January 2020 to February
2020. We performed an HCV-RNA blood capillary quick test on all newly arrived inmates. As a
routine, the new inmates underwent clinical and laboratory assessments. To those who were detected
HCV-RNA positive, the shortest possible antiviral treatment was offered, according to genotype
and clinical features.
Results: We observed 122 new inmates in the period between January and February of 2020. Overall,
62 (50.8%) subjects took HCV-RNA quick testing through blood sampling. Four (6.4%) subjects
were found to be HCV-RNA positive; 1 refused antiviral therapy, while 3 accepted, obtaining
100% SVR. None of the HCV-active inmates were lost to follow up between detection and treatment
proposal.
Conclusion: The use of a high-speed test-and-treat protocol for HCV infection was demonstrated
to be effective in avoiding LTFU in HCV-positive new inmates in the period between detection
and treatment. We observed an apparent prevalence of HCV incident cases in newly arrived inmates
of 6.4%. Antiviral therapy was quickly provided and found to be effective and successful.
