Long-Term Outcomes of a Decentralized, Nurse-Led, Statewide Model of Care for Hepatitis C Among People in Prison in Victoria, Australia

Abstract

Background: Prisons provide a key strategic opportunity to upscale hepatitis C testing and treatment in a high-prevalence setting and are crucial for elimination efforts.

Methods: A decentralized, statewide, nurse-led model of care offering hepatitis C treatment for people in prison was implemented in Victoria, Australia, in 2015. The program provides hepatitis C care at all 14 adult prisons in the jurisdiction. We prospectively evaluated treatment uptake between 1 November 2015 and 31 December 2021. Data on all people in prison who were treated were recorded in a clinical database. Primary outcomes were the number of people in prison who completed hepatitis C treatment with direct-acting antiviral (DAA) therapy and the proportion who achieved sustained virologic response (SVR12).

Results: A total of 3133 DAA treatment courses were prescribed to 2768 people in prison. The proportion of total Victoria DAA prescriptions the program was responsible for increased from 6% in 2016 to a peak of 23% in 2020. The median age was 39 years, 91% were male, and 9% had cirrhosis. Few (20%) had previously engaged in hepatitis C care in the community only 6% were treatment experienced. Complete follow-up data were available for 1757 of 2768 (63%) treated, with 1627 of 1757 (93%) achieving SVR12.

Conclusions: A decentralized, nurse-led, statewide model of care was highly effective in treating large numbers of people in prison with hepatitis C and achieved high rates of SVR12. Nurse-led prison programs are playing a crucial role in eliminating hepatitis C as a public health threat in Australia.

Keywords: direct-acting antiviral; elimination; hepatitis C virus; persons who inject drugs; prison.