ABSTRACT
Background: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) by 2025. With a reported HCV prevalence of about 6% in male prisons, and about 12% in female prisons, secure environments are an essential component of this elimination plan. Yorkshire is a region in England with a general population of about 3.7 M. PPG is the provider of healthcare to 9 prisons in Yorkshire, with approximately 6,000 residents, many of whom are current, or previous, substance users. Description of model of care/intervention: To support NHSE in the elimination of HCV, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT) was formed in 2019. This partnership works with prison and hospital teams to optimise test and treat pathways for new prison admissions. In addition, whole prison HCV Intensive Test and Treat events (HITT programmes) were run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Effectiveness: HCV screening, within 7 days of prison entry, increased from 27% in May 2019 to 93% in January 2022. This increase was achieved despite COVID-19 restrictions remaining in place since March 2020 across all English prisons. In addition, HITT programmes were used to test residents who were missed at prison entry. The overall result is that 8/9 prisons have achieved microelimination status, as defined by: >= 95% of prison residents tested within the previous 12 months, >= 90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Conclusion and next steps: Micro-elimination of HCV will now need to be maintained in these prisons by ensuring the uptake of HCV testing remains>95%. Plans are in place to micro-eliminate the final prison-which is a high-security prison presenting unique challenges to HCV micro-elimination.
ABSTRACT
Background and aims: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) in England by 2025, five years earlier than World Health Organisation goals. With a reported HCV prevalence of ∼6% in male prisons, and ∼12% in female prisons, secure environments are an essential component of this elimination plan. In 2020, NHSE defined HCV micro-elimination as ³95% of prison residents tested within the previous 12 months, ³90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Method: To support NHSE in their HCV Elimination Program, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT)was formed in 2019. PPG is the provider of healthcare to 47 English prisons with approximately 30, 000 residents. PPG Regional BBV Lead Nurses, and Gilead Medical Scientists worked with prison and HCV stakeholders to optimise test and treat pathways for new prison admissions. Whole prison HCV Intensive Test and Treat events (HITTs) were also run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Results: Following pathway optimisation across the PPG network of 47 prisons, the HCV screening within 7 days of prison entry increased from 41% in May 2019 to 84% in October 2021. This increase was achieved despite there being significant restrictions to reduce the transmission of COVID-19 being in place across all English prisons. HITTs have been performed in 15 PPG prisons to-date. 1, 909 new RNA+ diagnoses were made during this time with 1, 848 patients started on direct-acting antiviral treatments. By November 2021, 16 out of the 47 prisons have been given micro-elimination status by NHSE with 4 more having submitted data demonstrating achievement of this target and awaiting decision. A further 4 more prisons are on track to achieve micro-elimination by April 2022. Conclusion: This partnership has demonstrated that, even during a global pandemic, it is possible to achieve the micro-elimination of HCV in a defined setting. Maintenance of micro-elimination status is essential if we are to achieve the WHO HCV targets, requiring robust pathways that are regularly adapted to the changing environment, and systems for tracking performance, both of which have been put in place by this partnership.