The C-LINK Trial: A prospective randomised controlled trial showing than care-navigation post release from prisons increases linkage to hepatitis C care

Author: Timothy Papaluca Anne Craigie Lucy McDonald Amy Edwards Rebecca Winter Annabelle Hoang Alex Pappas Aoife Waldron Kelsey McCoy Mark Stoove Joseph Doyle Margaret Hellard Jacinta Holmes Michael MacIsaac Paul Desmond David Iser Alexander Thompson

Theme: Clinical Research Year: 2021

Background: Hepatitis C (HCV) treatment within prisons is safe and effective. Some prisoners, however, are released untreated. On community re-entry, individuals are faced with a number of immediate competing priorities, and in this context, linkage to HCV care is low. Interventions targeted at improving healthcare continuity following re-entry have yielded positive outcomes for other health diagnoses however data regarding HCV transitional care is limited. We evaluated the benefit of transitional care using a care-navigator model on the likelihood of HCV linkage to care amongst individuals released untreated. Methods: We conducted a prospective randomised controlled trial in which released prisoners with HCV were assigned to either care-navigation or standard-of-care. Care-navigation included telephone-based contact; providing HCV direct-acting antiviral (DAA) therapies; and reimbursement for DAA copayment, study participation time, and opioid substitution therapy (OST). Standard-of-care participants had a detailed HCV summary sent to a nominated healthcare provider. The primary outcome was prescription of HCV DAAs within six months of release. Results: 46 participants were randomised. The mean age was 35 and 62% were male. 90% (n=36/40) had injected drugs within 6 months of incarceration. 28% were prescribed OST. 50% self-reported psychiatric diagnoses. 22 were randomised to care-navigation and 24 to standard-of-care. 73% (n=16/22) in the care-navigation and 33% (n=8/24) in the standard-of-care group were prescribed HCV DAAs within six months of release (p=0.02). Time to DAA prescription was shorter amongst carenavigation participants (21 days [10-42] vs 82 days [44-99] p=0.049). The sole predictor of DAA prescription amongst those receiving care-navigation was ability to successfully contact participants following release (93%, n=14/15 vs 28%, n=2/7, p=0.01). Conclusion: HCV transitional care for individuals re-entering the community is associated with a higher likelihood of DAA initiation and reduced time to treatment. Treatment rates amongst unsupported individuals are low. Similar programs should be implemented to contribute towards HCV elimination. Disclosure of interest statement: There are no disclosures of interest of note in regard to this research.

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