Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Australia.
Burnet Institute, Melbourne, Australia.
J Hepatol. 2019 May;70(5):839-846. doi: 10.1016/j.jhep.2019.01.012. Epub 2019 Jan 14.
BACKGROUND & AIMS: Treatment programs for people who inject drugs (PWID), including prisoners, are important for achieving hepatitis C elimination targets. There are multiple barriers to treatment of hepatitis C in prisons, including access to specialist physicians, testing and antiviral therapy, short prison sentences, and frequent inter-prison transfer. We aimed to assess the effectiveness of a nurse-led model of care for the treatment of prisoners with hepatitis C.
A statewide program for assessment and management of hepatitis C was developed in Victoria, Australia to improve access to care for prisoners. This nurse-led model of care is supported by telemedicine to provide decentralized care within all prisons in the state. We prospectively evaluated the feasibility and efficacy of this nurse-led model of care for hepatitis C within the 14 adult prisons over a 13-month period. The primary endpoint was sustained virological response at post-treatment week 12 (SVR12) using per protocol analysis.
There were 416 prisoners included in the analysis. The median age was 41 years, 90% were male, 50% had genotype 3 and 44% genotype 1 hepatitis C and 21% had cirrhosis. Injecting drug use was reported by 68% in the month prior to prison entry, 54% were receiving opioid substitution therapy, and 86% reported never previously engaging with specialist HCV care. Treatment duration was 8 weeks in 24%, 12 weeks in 59%, and 24 weeks in 17% of treatment courses. The SVR12 rate was 96% (301/313) per protocol. Inter-prison transfer occurred during 26% of treatment courses but was not associated with lower SVR12 rates. No treatment-related serious adverse events occurred.
Hepatitis C treatment using a decentralized, nurse-led model of care is highly effective and can reach large numbers of prisoners. Large scale prison treatment programs should be considered to support hepatitis C elimination efforts.
There is a high burden of hepatitis C infection among prisoners worldwide. Prisoners who continue to inject drugs are also at risk of developing new infections. For this reason, the prison setting provides an opportunity to treat those people at greatest risk of infection and to stop transmission to others. We developed a new method of providing hepatitis C treatment to prisoners, in which nurses rather than doctors assessed prisoners locally at each prison site. Treatment was safe and most prisoners were cured. Such programs will contribute greatly to achieving the World Health Organization's hepatitis C elimination goals.
为实现丙型肝炎消除目标，为包括囚犯在内的注射毒品者（PWID）提供治疗方案非常重要。在监狱中治疗丙型肝炎存在多种障碍，包括获得专科医生、检测和抗病毒治疗、刑期短以及频繁的监狱间转移。我们旨在评估一种护士主导的护理模式在治疗丙型肝炎囚犯中的有效性。
澳大利亚维多利亚州开发了一项针对丙型肝炎评估和管理的全州性计划，以改善囚犯获得护理的机会。这种护士主导的护理模式得到远程医疗的支持，可为该州所有监狱内提供分散式护理。我们前瞻性地评估了该护士主导的护理模式在 13 个月内治疗 14 所成人监狱内丙型肝炎的可行性和疗效。主要终点是根据方案分析治疗后第 12 周的持续病毒学应答（SVR12）。
共有 416 名囚犯纳入分析。中位年龄为 41 岁，90%为男性，50%基因型为 3，44%基因型为 1 型丙型肝炎，21%有肝硬化。入狱前 1 个月有 68%的人报告有注射吸毒史，54%正在接受阿片类药物替代治疗，86%报告从未接受过丙型肝炎专科治疗。24%的治疗疗程持续 8 周，59%的疗程持续 12 周，17%的疗程持续 24 周。根据方案，SVR12 率为 96%（301/313）。在 26%的治疗疗程中发生了监狱间转移，但与较低的 SVR12 率无关。无治疗相关的严重不良事件发生。
使用分散的、以护士为主导的护理模式治疗丙型肝炎非常有效，可以覆盖大量囚犯。应考虑大规模的监狱治疗计划，以支持丙型肝炎消除工作。
为实现丙型肝炎消除目标，为包括囚犯在内的注射毒品者（PWID）提供治疗方案非常重要。在监狱中治疗丙型肝炎存在多种障碍，包括获得专科医生、检测和抗病毒治疗、刑期短以及频繁的监狱间转移。我们旨在评估一种护士主导的护理模式在治疗丙型肝炎囚犯中的有效性。
澳大利亚维多利亚州开发了一项针对丙型肝炎评估和管理的全州性计划，以改善囚犯获得护理的机会。这种护士主导的护理模式得到远程医疗的支持，可为该州所有监狱内提供分散式护理。我们前瞻性地评估了该护士主导的护理模式在 13 个月内治疗 14 所成人监狱内丙型肝炎的可行性和疗效。主要终点是根据方案分析治疗后第 12 周的持续病毒学应答（SVR12）。
共有 416 名囚犯纳入分析。中位年龄为 41 岁，90%为男性，50%基因型为 3，44%基因型为 1 型丙型肝炎，21%有肝硬化。入狱前 1 个月有 68%的人报告有注射吸毒史，54%正在接受阿片类药物替代治疗，86%报告从未接受过丙型肝炎专科治疗。24%的治疗疗程持续 8 周，59%的疗程持续 12 周，17%的疗程持续 24 周。根据方案，SVR12 率为 96%（301/313）。在 26%的治疗疗程中发生了监狱间转移，但与较低的 SVR12 率无关。无治疗相关的严重不良事件发生。
使用分散的、以护士为主导的护理模式治疗丙型肝炎非常有效，可以覆盖大量囚犯。应考虑大规模的监狱治疗计划，以支持丙型肝炎消除工作。
