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Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study

2021; Elsevier BV; Volume: 6; Issue: 7 Linguagem: Inglês

10.1016/s2468-1253(21)00077-7

2468-1253

Behzad Hajarizadeh, Jason Grebely, Marianne Byrne, Pip Marks, Janaki Amin, Hamish McManus, Tony Butler, Evan B. Cunningham, Peter Vickerman, Natasha K. Martin, John G. McHutchison, Diana M. Brainard, Carla Treloar, Georgina M. Chambers, Luke Grant, Colette McGrath, Andrew R. Lloyd, Gregory J. Dore, Stuart Loveday, Gregory J. Dore, Andrew R. Lloyd, Jason Grebely, Tony Butler, Georgina M. Chambers, Carla Treloar, Marianne Byrne, Behzad Hajarizadeh, Pip Marks, Mahshid Tamaddoni, Stephanie Obeid, Gerard Estivill Mercade, María Martínez-Martínez, Roy Donnelly, Colette McGrath, Julia Bowman, Lee Trevethan, Katerina Lagios, Luke Grant, Terry Murrell, Nicky Bath, Victor Tawil, Annabelle Stevens, Libby Topp, Alison Churchill, Kate Pinnock, Natasha K. Martin, Steve Drew, Mary Harrod, Angela R. Smith, Ronella Williams, Brigid Cooper, Kelly Somes, Carina Burns, Anoop Kaur, Camilla Lobo, K. D. Conroy, Luke McCredie, Carolyn Café, Jodie Anlezark, William D. Rawlinson, Malinna Yeang, Matthew Wynn, Christiana Willenborg,

HIV, Drug Use, Sexual Risk

Background: Limited empirical evidence exists for hepatitis C virus (HCV) treatment-asprevention.The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study assessed HCV treatment-as-prevention in four Australian prisons.Methods: SToP-C is a non-randomised trial, including a pre/post analysis within a prospective longitudinal cohort of people incarcerated in two maximum-(male) and two medium-security prisons (one male, one female).All prison inmates at least 18 years were eligible for enrolment.Participants were enrolled from late-2014 to 2019.Following HCV testing, participants were monitored for risk behaviors and HCV, among three sub-populations: 1) uninfected (HCV antibody negative); 2) previously infected (HCV antibody positive, HCV RNA negative); 3) infected (HCV antibody and HCV RNA positive).Uninfected and previously infected (at-risk) participants were followed every 3-6 months for HCV primary infection and re-infection, respectively.Infected participants were assessed for treatment, initially standard of care treatment (by prison health services), followed by direct-acting antiviral (DAA) treatment scale-up from mid-2017 (12 weeks sofosbuvir/velpatasvir, through SToP-C).Participants were followed until study closure in November 2019.The primary study outcome was HCV incidence compared between pre-and post-treatment scale-up periods among participants at risk of HCV primary infection or re-infection.The trial was registered with ClinicalTrials.gov(identifier: NCT02064049) Findings: Of 3,691 participants enrolled, 719 (19%) had detectable HCV RNA and 2,965 were at-risk of primary infection (n=2,240) or re-infection (n=725) at baseline.DAA treatment was initiated in 349/499 eligible participants during the treatment scale-up period.Among at-risk population with longitudinal follow-up (n=1,643; median age 33 years; 82% male), 31% reported injecting drug use in prison.HCV incidence declined by 48%, from 8.31 to 4.35/100 person-years between pre-and post-treatment scale-up periods [Incidence Rate Ratio (IRR): 0.52, 95%CI: 0.36, 0.78].Incidence of primary infection declined from 6.64 to 2.85/100 personyears (IRR: 0.43, 95%CI: 0.25, 0.74), while incidence of re-infection declined from 12.36 to 7.27/100 person-years (IRR: 0.59, 95%CI: 0.35, 1.00).Among participants reporting injecting drug use in the current imprisonment, incidence of primary infection declined from 39.08 to 14.03/100 person-years (IRR: 0.36, 95%CI: 0.16, 0.80), and incidence of re-infection declined from 15.26 to 9.34/100 person-years (IRR: 0.61, 95%CI: 0.34, 1.09).Adjusted analysis indicated a significant reduction in HCV risk between pre-and post-treatment scale-up periods (adjusted Hazard Ratio: 0.50, 95% CI: 0.33, 0.76).Interpretation: DAA treatment scale-up was associated with reduced HCV incidence in prison, indicative of HCV treatment-as-prevention.The findings support broad DAA treatment scale-up among incarcerated populations.