Work

O7 Moving towards HCV elimination in HIV/HCV co- infection in Australia following universal access to interferon-free therapy

Year: 2017

Type: article

Abstract: Background: HCV transmission is high in prisons.The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study in New South Wales, Australia consists of two major phases: i)Surveillance, HCV status and risk behaviour are evaluated at study entry and monitored longitudinally; ii)Treatment scale-up, participants with detected HCV-RNA are offered sofosbuvir/velpatasvir.This analysis assessed HCV incidence in two SToP-C maximum-security prisons before treatment scale-up.Methods: Surveillance phase data of participants enrolled during October 2014-November 2016 with at least one follow-up visit was used.Participants were screened for HCV-antibody (Ab) and HCV-RNA at enrolment.HCV-Ab or HCV-RNA negative participants were tested every six months.Those with HCV-Ab negative and HCV-Ab positive/ HCV-RNA negative were considered at risk of HCV primary infection and reinfection, respectively.Results: Among 748 participants screened, 171 were included in analysis (122 and 49 were at risk of HCV primary infection and reinfection, respectively; Median age 36 years; median duration of stay at the prison 4 years).During 178 person-years (py) of follow-up, 9 incident infections were observed, including 5 primary and 4 reinfections.HCV incidence was 5.1/100 py (95%CI: 2.6-9.7).All 9 participants with incident HCV reported ever injecting drug use (IDU), and 5 reported IDU in the past month in prison.Among those reporting ever IDU, overall HCV incidence was 13.0/100 py (95% CI: 6.8-25.0);primary infection incidence was 18.6/100 py (95% CI: 7.7-44.7);and reinfection incidence was 9.4/100 py (95% CI: 3.5-25.1).Among those reporting IDU in the past month, HCV incidence was 35.5/100 py (95% CI: 14.8-85.3),while all participants with incident HCV (n=5) reported sharing needle/syringe.Conclusion: High HCV incidence was found in SToP-C maximumsecurity prisons, supporting the need for comprehensive prevention strategies, including harm reduction and a HCV treatment-asprevention evaluation.HCV transmission was primarily associated with IDU, particularly recent IDU in prison.

Source: Journal of Virus Eradication

DOI: 10.1016/s2055-6640(20)30890-6