Search

Introduction: Prison settings represent the highest concentration of prevalent hepatitis C cases in Australia due to the high rates of incarceration among people who inject drugs. Highly effective direct‐acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection are available to people incarcerated in Australian prisons. However, multiple challenges to health care implementation in the prison sector present barriers to people in prison reliably accessing hepatitis C testing, treatment, and prevention measures. Main recommendations: This Consensus statement highlights important considerations for the management of hepatitis C in Australian prisons. High coverage testing, scale‐up of streamlined DAA treatment pathways, improved coverage of opioid agonist therapy, and implementation and evaluation of regulated provision of prison needle and syringe programs to reduce HCV infection and reinfection are needed. Changes in management as a result of this statement: The recommendations set current best practice standards in hepatitis C diagnosis, treatment and prevention in the Australian prison sector based on available evidence. Prison‐based health services should strive to simplify and improve efficiency in the provision of the hepatitis C care cascade, including strategies such as universal opt‐out testing, point‐of‐care testing, simplified assessment protocols, and earlier confirmation of cure. Optimising hepatitis C management in prisons is essential to prevent long term adverse outcomes for a marginalised population living with HCV. Scale‐up of testing and treatment in prisons will make a major contribution towards Australia's efforts to eliminate hepatitis C as a public health threat by 2030. [ABSTRACT FROM AUTHOR]

Retention in opioid agonist treatment (OAT) following release from prison is associated with improved outcomes, however factors associated with post-release OAT discontinuation in Australia are poorly understood. We examined post-release OAT discontinuation in a cohort of men who engaged in approximately monthly injecting drug use (IDU) prior to imprisonment in Victoria, Australia. Longitudinal data were used to calculate incidence of first-event post-release OAT discontinuation among men released from prison receiving OAT, and single-event discrete-time survival methods were used to estimate associations with post-release OAT discontinuation. Among 110 participants, 55 OAT discontinuations were observed in the two years post-release, an overall crude incidence rate (IR) of 46 per 100 person-years (PY) (95 % confidence interval [95 %CI]: 36–60 per 100PY). Incidence was greatest between release from prison and first follow-up (IR: 84 per 100PY, 95 %CI: 62–116 per 100PY). Initiating OAT during index imprisonment (versus transitioning from community OAT; adjusted hazard rate [AHR]: 2.17, 95 %CI: 1.14–4.13) and identifying as Aboriginal and/or Torres Strait Islander (AHR: 4.95, 95 %CI: 2.00–12.25) were associated with an increased hazard of OAT discontinuation. In a cohort of men with recent histories of IDU released from prison receiving OAT, half reported OAT discontinuation within two years of release from prison, with incidence of discontinuation greatest soon after prison-release. Targeted support for men who initiate OAT during episodes of imprisonment and Aboriginal and/or Torres Strait Islander peoples is necessary to reduce incidence of OAT discontinuation among people at greatest risk of discontinuation. • We studied opioid agonist treatment (OAT) discontinuation among men exiting prison. • Half of participants discontinued OAT within two years of release. • Incidence of OAT discontinuation was greatest in the first observation period. • Targeted support to at-risk groups may reduce post-release discontinuation. [ABSTRACT FROM AUTHOR]

Following the availability of highly effective direct-acting antivirals (DAAs) to treat hepatitis C infection, the uptake of treatment by people living with hepatitis C rose dramatically in high- and middle-income countries but has since declined. To achieve the World Health Organization's (WHO) 2030 target to eliminate hepatitis C as a public health threat among people who inject drugs, an increase in testing and treatment is required, together with improved coverage of harm reduction interventions. The population that remains to be treated in high- and middle-income countries with high hepatitis C prevalence are among the most socially disadvantaged, including people who inject drugs and are involved in the criminal justice system, a group with disproportionate hepatitis C prevalence, compared with people in the wider community. Imprisonment provides an unrivalled opportunity for screening and treating large numbers of people for hepatitis C, who may not access mainstream health services in the community. Despite some implementation challenges, evidence of the efficacy, acceptability, and cost-effectiveness of in-prison hepatitis treatment programs is increasing worldwide, and evaluations of these programs have demonstrated the capacity for treating people in high numbers. In this Perspective we argue that the scale-up of hepatitis C prevention, testing, and treatment programs in prisons, along with the investigation of new and adapted approaches, is critical to achieving WHO elimination goals in many regions; the Australian experience is highlighted as a case example. We conclude by discussing opportunities to improve access to prevention, testing, and treatment for people in prison and other justice-involved populations, including harnessing the changed practices brought about by the COVID-19 pandemic.

Introduction and Aims: Once involved in the criminal justice system, people who inject drugs (PWID) have a high probability of multiple system encounters. Imprisonment typically fails to rehabilitate PWID, who upon return to the community are at considerable risk of returning to injecting drug use (IDU) and poor health and social outcomes. We examined the effect of IDU resumption, and a suite of other sociodemographic, criminogenic, health and behavioural indicators, on the timing of reincarceration among adults with a history of IDU following release from prison., Design and Methods: Structured interviews were conducted with 561 PWID in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post-release. Data were linked prospectively with correctional records and the National Death Index. Data collected at multiple time-points were treated as time-varying covariates. Kaplan-Meier survival estimates and Cox proportional hazards models were used to estimate the rate and hazards of reincarceration., Results: Sixty-eight percent of participants (n = 350) were reincarcerated over a combined observation time of 1043.5 years, representing a rate of 33.5 per 100 person-years (95% confidence interval [CI] 30.2-37.2). Time-invariant predictors of reincarceration in PWID were: male gender (adjusted hazard ratio [AHR] = 1.62, 95% CI 1.19-2.21), older age at release (AHR = 0.97, 95% CI 0.95-1.00), previous adult (AHR = 2.00, 95% CI 1.41-2.84) or juvenile (AHR = 1.78, 95% CI 1.27-2.49) imprisonment, shorter imprisonment (≤90 days vs. >365 days, AHR = 2.09, 95% CI 1.30-3.34), release on parole (AHR = 2.29, 95% CI 1.82-2.88) and drug-related sentence (AHR = 1.84, 95% CI 1.34-2.53). Time-varying predictors included resumption of IDU (AHR = 2.04, 95% CI 1.60-2.61), unemployment (AHR = 1.53, 95% CI 1.07-2.19) and low perceived social support (AHR = 1.41, 95% CI 1.05-1.90). Very-high psychological distress at the most recent interview was protective against reincarceration (AHR = 0.65, 95% CI 0.44-0.95)., Discussion and Conclusions: Efforts to prevent resumption of IDU and address disadvantage, social inclusion and health service access in ex-prisoners through the scale-up and integration of prison-based and post-release interventions are likely to reap both public health and criminal justice benefits., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)