Hepatitis C Virus Reinfection Following Direct-Acting Antiviral Treatment in the Prison Setting: The SToP-C Study.

BACKGROUND

Injection drug use (IDU) following treatment for hepatitis C virus (HCV) infection may lead to reinfection, particularly if access to harm reduction services is suboptimal. This study assessed HCV reinfection risk following direct-acting antiviral therapy within Australian prisons that had opioid agonist therapy (OAT) programs but did not have needle and syringe programs (NSPs).

METHODS

The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study enrolled people incarcerated in 4 prisons between 2014 and 2019. Participants treated for HCV were followed every 3-6 months to identify reinfection (confirmed by sequencing). Reinfection incidence and associated factors were evaluated.

RESULTS

Among 388 participants receiving treatment, 161 had available posttreatment follow-up and were included in analysis (92% male; median age, 33 years; 67% IDU in prison; median follow-up 9 months). Among those with recent (in the past month) IDU (n = 71), 90% had receptive needle/syringe sharing. During 145 person-years (PY) of follow-up, 18 cases of reinfection were identified. Reinfection incidence was 12.5/100 PY (95% confidence interval [CI]: 7.9-19.8) overall, increasing to 28.7/100 PY (95% CI: 16.3-50.6) among those with recent IDU and needle/syringe sharing. In adjusted analysis, recent IDU with needle/syringe sharing was associated with increased reinfection risk (adjusted hazard ratio [aHR], 4.74 [95% CI: 1.33-16.80]; P = .016) and longer HCV testing interval with decreased risk (ie, chance of detection; aHR, 0.41 per each month increase [95% CI: .26-.64]; P < .001).

CONCLUSIONS

A high rate of HCV reinfection was observed within prison. Posttreatment surveillance and retreatment are -essential to limit the impact of reinfection. High-coverage OAT and NSPs should be considered within prisons.

CLINICAL TRIALS REGISTRATION

NCT02064049.

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [e-mail].

Déclaration de conflit d'intérêts

Potential conflicts of interest. A. R. L. and G. J. D. were supported by NHMRC Practitioner Fellowships. J. G. was supported by an NHMRC Investigator Grant. E. C. is supported by a postdoctoral fellowship from the Canadian Network on Hepatitis C. P. V. acknowledges support from the US National Institute on Drug Abuse (NIDA; grant numbers R01AI147490, R01DA033679, R01DA037773, R21DA046809, and R01DA047952); the National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions and Behavioral Science at the University of Bristol; and the NIHR-funded EPIToPe project. N. K. M. acknowledges support from the US National Institute of Allergy and Infectious Diseases and NIDA (grant number R01AI147490), and the University of California, San Diego Center for AIDS Research, a program funded by the US National Institutes of Health (grant number P30 AI036214). C. T. reports research funds, unrelated to this project, paid to the institution from Merck, and speaker’s fees from AbbVie and Gilead. G. J. D. reports research grants outside the submitted work from AbbVie, Gilead Sciences, and Merck. G. V. M. reports research grants from AbbVie and Gilead, outside the submitted work, and payment or honoraria from Janssen (speaker’s bureau) and AstraZeneca (advisory board). J. G. reports grants or contracts outside the submitted work from AbbVie, Camurus, Cepheid, Hologic, Indivior, and Merck and payment or honoraria from AbbVie, Cepheid, Gilead Sciences, and Merck. N. K. M. reports unrestricted research grants to the university unrelated to this research from Gilead and Merck. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.