Theme: Models of Care Year: 2021
Background: In England, injection drug use (IDU) accounts for 90% HCV infections. A strong association exists between recent IDU and acquisitive crime, with 40% prisoners believed to have injected drugs prior to incarceration and 6% HCV prevalence in prison. Many prisoners don’t routinely engage with healthcare outside prison; thus, incarceration represents an opportunity to diagnose and treat their HCV. Despite opt-out HCV testing in prisons launching in 2014, testing remained at 25% in Dec2018 across these 47 prisons. Description of model of care/intervention: To support the NHS England HCV Elimination Program, in May2019 we implemented a partnership between Gilead, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT) to eliminate HCV within the PPG-healthcare prison estate. We employed a regional blood-borne virus (BBV) lead team within PPG and a National Prison Partnership HITT (HCV Intensive Test and Treat) Manager within HCT. In partnership with Gilead colleagues, the teams focus on improving reception screening for BBVs, care pathway development for those diagnosed and implementing HITTs to ‘test-and-treat’ those already incarcerated, to enable elimination within a prison. Effectiveness: 67,569 HCV tests were performed across the prisons 1May2019 through 31Mar2021, through reception and post-reception activity (including 11 HITTs). 1,504 prisoners were newly recorded as HCV RNA+. 1,457 prisoners were initiated on therapy. Four prisons have to-date achieved HCV elimination (95% prisoners tested in last 12 months and 90% RNA+ patients initiating treatment). Monthly testing rates continue to increase and a further 10 HITT events are scheduled for 2021. Data will be presented summarising longitudinal testing, diagnosis and treatment numbers. Conclusion and next steps: A multi-year partnership between pharma, healthcare services and a patient organisation has led to notable rapid improvements in HCV diagnosis and management in 47 prisons, with only a short-term impact of COVID-19. Disclosures: The regional blood-borne virus (BBV) nurse team within PPG and National Prison Partnership HITT Manager within the Hepatitis C Trust are fully funded by Gilead. Gilead plays an active role in the design and execution of the activities that form this Prison HCV Elimination Program.
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