A Pilot Program Of Screening And Linkage To Care For Hepatitis C In A Greek Prison

Author: Sypsa V, Kalamitsis G, Papatheodoridis G, Georgoulas S, Psichogiou M, Paraskevis D, Dragassaki M, Haikalis S, Malekian H, Roussos S, Daikos G, Hatzakis A

Theme: Models of Care Year: 2018

Background: In Greece, people who inject drugs (PWID) with chronic hepatitis C are eligible to receive treatment with Direct Acting Antivirals (DAAs) if they fulfill the following criteria: fibrosis≥7.0kPa or coinfection with HIV. Although PWID constitute a large proportion of the prisoner population, there are no data on HCV burden neither an established procedure for HCV screening/linkage to care in Greek prisons. Approach: A pilot program is implemented in the largest Greek prison (Korydallos) and in Korydallos Prison Hospital in Athens with the aim of screening for HCV and facilitating linkage to care. A team consisting of a physician and a psychologist visit the prison hospital along with a person from the Hellenic Liver Patient Association “Prometheus” with a mobile fibroscan device. After obtaining informed consent, the European Questionnaire on Drug Use among Prisoners is administered and prisoners are tested for HCV (including HCVRNA and HCV genotype)/HIV/HBV/tuberculosis and undergo transient elastography. Participants are informed about their test results and receive pre- and post-test counseling. Outcome: During October 2017-March 2018, 329 prisoners were enrolled. Of 200 prisoners with history of injecting drug use, 167 (83.5%) were anti-HCV positive and 109 (55.9%) were anti-HIV positive. In total, 114/200 PWID (57.0%) had chronic hepatitis C and fulfilled treatment criteria; 27 with fibrosis score≥7.0kPa and 87 coinfected with HIV. Based on the questionnaire, 56.1% of chronically infected PWID reported that they had been previously diagnosed and 7.0% had received treatment in the past. Conclusion: Despite the existing restrictions on access to DAAs in Greece, the program identified a large number of imprisoned PWID eligible to treatment. It was successful in overcoming barriers in screening and subsequent linkage to treatment (lack of fibroscan, cost of HCVRNA/genotype) and it is intended to implement it in other Greek prisons too. Disclosure of interest statement: The program was funded by Gilead Europe

Download abstract Download Poster