Eliminating hcv infection from prisons in sicily: the sintesi project

Background In all countries HCV among prisoners has a higher prevalence than in the general population. Specific models of screening and linkage to care are needed to improve the care cascade. Methods The SIcilian Network for Therapy, Epidemiology and Screening In Hepatology (SINTESI) run an HCV point-of-care project in all 23 prisons of Sicily.All prisoners received information on HCV screening and the possibility of receiving treatment with Direct Acting Antiviral (DAA) while incarcerated. HCV status was assessed by screening all subjects for anti-HCV by rapid oral test (OraQuick HCV) and immediate reflex testing for HCV-RNA (GeneXpert-HCV Viral Load, Cepheid). HCV RNA positive subjects received DAA therapy within 72 hours of screening. All prisoners signed an informed consent to use personal data. Chi-square test was used to analyze differences between groups Result Among 5,912 prisoners (98% of prison population) informed of the screening project, 4,911 (83%) accepted to undergo HCV testing. The mean age was 42 years (range 18-86) and 95.8% was males. Non-Italian origin accounted for 12.2% of prisoners (3.7% other EU countries, 7.5% Africa, 0.6% Asia and 0.2% South America). Overall, 245 subjects (5%) testes anti HCV positive, with a prevalence of 4.9% among males and 6.7% among females (p=0.25). We evaluated the risk of drug addiction in subjects with HCV infection in a prison. A prevalence of 25% (25/99) was found among PWUDs on opioid substitution, as compared to 2.9% (30/1,040) in non-PWUDs (p<0.0001). Among 245 anti HCV positive prisoners, 20 refused to be tested for HCV-RNA, 100 tested negative (80 had a history of viral clearance under previous DAA treatment while 20 did not report previous therapy for HCV) and 125 were HCV-RNA positive. Twelve of the latter refused treatment, while 113 started a cycle of DAAs while incarcerated. Among 56 subjects assessable for SVR, 55 (98%) obtained HCV clearance. Conclusions In Sicily, HCV infection is 4 times more common among people in prison than in the general population mostly due to parenteral drug use. Half of the prisoners with a positive screening were unaware of their HCV status and only 32% had received DAAs previously. A one-shot HCV test-and-treat point-of-care approach is highly effective in this setting.