MacIsaac Michael B, Papaluca Timothy, McDonald Lucy, Craigie Anne, Edwards Amy, Layton Chloe, Gibson Annabelle, Winter Rebecca J, Iyer Kiran, Sim Abigail, Evans Sophia, Kumaragama Kavindu, Howell Jessica, Desmond Paul, Iser David, Scott Nick, Hellard Margaret, Stoové Mark, Wilson David, Pedrana Alisa, Doyle Joseph S, Holmes Jacinta A, Thompson Alexander J
Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Clin Infect Dis. 2025 Apr 30;80(4):826-834. doi: 10.1093/cid/ciae471.
Prisons provide a key strategic opportunity to upscale hepatitis C testing and treatment in a high-prevalence setting and are crucial for elimination efforts.
A decentralized, statewide, nurse-led model of care offering hepatitis C treatment for people in prison was implemented in Victoria, Australia, in 2015. The program provides hepatitis C care at all 14 adult prisons in the jurisdiction. We prospectively evaluated treatment uptake between 1 November 2015 and 31 December 2021. Data on all people in prison who were treated were recorded in a clinical database. Primary outcomes were the number of people in prison who completed hepatitis C treatment with direct-acting antiviral (DAA) therapy and the proportion who achieved sustained virologic response (SVR12).
A total of 3133 DAA treatment courses were prescribed to 2768 people in prison. The proportion of total Victoria DAA prescriptions the program was responsible for increased from 6% in 2016 to a peak of 23% in 2020. The median age was 39 years, 91% were male, and 9% had cirrhosis. Few (20%) had previously engaged in hepatitis C care in the community only 6% were treatment experienced. Complete follow-up data were available for 1757 of 2768 (63%) treated, with 1627 of 1757 (93%) achieving SVR12.
A decentralized, nurse-led, statewide model of care was highly effective in treating large numbers of people in prison with hepatitis C and achieved high rates of SVR12. Nurse-led prison programs are playing a crucial role in eliminating hepatitis C as a public health threat in Australia.
监狱为在高流行环境中扩大丙型肝炎检测和治疗提供了关键的战略契机，对消除丙型肝炎的努力至关重要。
2015年，澳大利亚维多利亚州实施了一种分散式、全州范围的、由护士主导的护理模式，为监狱中的人员提供丙型肝炎治疗。该项目在辖区内的所有14所成人监狱提供丙型肝炎护理。我们前瞻性评估了2015年11月1日至2021年12月31日期间的治疗接受情况。所有接受治疗的监狱人员的数据都记录在一个临床数据库中。主要结局是完成直接抗病毒（DAA）疗法丙型肝炎治疗的监狱人员数量以及实现持续病毒学应答（SVR12）的比例。
共为2768名监狱人员开出了3133个DAA治疗疗程。该项目负责的维多利亚州DAA处方总数的比例从2016年的6%增至2020年的峰值23%。中位年龄为39岁，91%为男性，9%有肝硬化。很少有人（20%）此前仅在社区接受过丙型肝炎护理，只有6%有治疗经历。2768名接受治疗者中有1757名（63%）有完整的随访数据，1757名中有1627名（93%）实现了SVR12。
一种分散式、由护士主导的全州护理模式在治疗大量监狱丙型肝炎患者方面非常有效，并实现了高SVR12率。由护士主导的监狱项目在澳大利亚消除丙型肝炎作为公共卫生威胁方面发挥着关键作用。
