In the United States, a federal class-action lawsuit was filed last month alleging that people incarcerated in Department of Corrections facilities in the state of Nevada do not have adequate access to direct-acting antivirals (DAAs), the standard of care for the treatment and cure of chronic hepatitis C.

According to an article in the Las Vegas Review-Journal, two individuals have been named as plaintiffs, but the lawsuit is intended to represent all people in the state who are incarcerated and suffer from hepatitis C. Lawsuits over access to DAAs have been filed in several other states, including Missouri, Colorado, Kansas, Connecticut, and Pennsylvania.

As many as 1 in 3 people suffer from hepatitis C in US prisons and jails. Meanwhile, in such environments, the disconnect between health care services and the patient can be effectively minimized. As such, prisons are a favourable setting in which to engage a heavily-affected population.

Results from real-world initiatives in Australia, Spain and Italy support the idea that introducing testing and treatment with DAAs for hepatitis C in prisons can have positive impacts both for the individual and at the population level. Modelling studies also suggest that doing so could be effective in reducing both prevalence and incidence of the disease.

Indeed, there may be challenges to microelimination strategies in prisons and jails: for example, reinfection may be a risk if harm reduction measures (for example, needle exchanges) are not in place, and high levels of transitioning may bring about loss to followup, especially if linkages between prison and community care is weak.

However, health programming taking a harm reduction approach, as well as good planning and communication between carceral and community health care providers, may help to overcome such hurdles.

Read the full article in the Las Vegas Review-Journal.

For more on modelling the impact of hepatitis C treatment with DAAs in prisons:

The role of prison-based interventions for hepatitis C virus (HCV) micro-elimination among people who inject drugs in Montreal, Canada by Godin et al. [Preprint]. https://doi.org/10.1101/19008409

HCV elimination: breaking down the barriers to prison based care by Papaluca & Thompson. 2018. http://dx.doi.org/10.20517/2394-5079.2018.53

Modelling the impact of incarceration and prison‐based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland by Stone et al. 2017. https://doi.org/10.1111/add.13783

Image “Prison Tower Sunset” by Jobs for Felons Hub is licensed under CC BY 2.0.