[Comment] Treatment-as-prevention in prison settings: a growing evidence base for HCV elimination efforts

Progress towards the elimination of hepatitis C virus (HCV) is underway globally, with some countries such as Australia moving forward at a fast pace. Gamkrelidze I Pawlotsky J Lazarus JV et al. Progress towards hepatitis C virus elimination in high-income countries: an updated analysis.

Liver Int. 2021; 41: 456-463

A micro-elimination approach for HCV was advocated early on to guide efforts towards the achievement of WHO's HCV elimination goals. Due to their disproportionate burden of disease and increased risk of acquiring HCV infection, the prison population has been highlighted for tailored interventions, including active case finding, streamlined linkage to care, and decentralised treatment with direct-acting antiviral (DAA) drugs. Vroling H Oordt-Speets AM Madeddu G et al. A systematic review on models of care effectiveness and barriers to Hepatitis C treatment in prison settings in the EU/EEA.

J Viral Hepat. 2018; 25: 1406-1422

Oru E Trickey A Shirali R Kanters S Easterbrook P Decentralisation, integration, and task-shifting in hepatitis C virus infection testing and treatment: a global systematic review and meta-analysis.

Lancet Glob Health. 2021; 9: e431-e445

Yet, access to HCV care in prisons is not well documented, with a heterogeneous scenario emerging as a result of scarce data on treatment availability and coverage. Nakitanda AO Montanari L Tavoschi L Mozalevskis A Duffell E Hepatitis C virus infection in EU/EEA and United Kingdom prisons: opportunities and challenges for action.

BMC Public Health. 2020; 201670

Structural, logistical, management, and sometimes political issues make it difficult to include prison settings in broader public health programmes. The application of evidence-based and data-driven decision making to prison health services, although strongly advocated, UNODCWHO Regional Office for Europe
Good governance for prison health in the 21st century: a policy brief on the organization of prison health. is hampered by the scarcity of robust and well conducted operational research in prison settings. Vroling H Oordt-Speets AM Madeddu G et al. A systematic review on models of care effectiveness and barriers to Hepatitis C treatment in prison settings in the EU/EEA.

J Viral Hepat. 2018; 25: 1406-1422

Oru E Trickey A Shirali R Kanters S Easterbrook P Decentralisation, integration, and task-shifting in hepatitis C virus infection testing and treatment: a global systematic review and meta-analysis.

Lancet Glob Health. 2021; 9: e431-e445

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