2E-5 HEPATITIS C TREATMENT IN UNITED STATES PRISONS PREVENTS TRANSMISSION IN SOCIETY

Monday, October 24, 2016: 5:00 PM
Bayshore Ballroom Salon E, Lobby Level (Westin Bayshore Vancouver)

Jagpreet Chhatwal, PhD, MGH Institute for Technology Assessment and Harvard Medical School, Boston, MA, Kan Li, MS, The University of Texas Health Science Center at Houston, Houston, TX, Tianhua He, Tsinghua University School of Medicine, Beijing, China, Mark S. Roberts, MD, MPH, University of Pittsburgh School of Medicine, Pittsburgh, PA, Turgay Ayer, PhD, Georgia Insitute of Technology, Atlanta, GA, Sumeyye Samur, PhD, MGH Institite for Technology Assessment and Harvard Medical School, Boston, MA, John Grefenstette, PhD, Public Health Dynamics Lab, University of Pittsburgh, Pittsburgh, PA and Anne Spaulding, MD, Emory University, Atlanta, GA
Purpose: Hepatitis C virus (HCV) seroprevalence among United States prisoners is ~17%, in contrast to 1% in the general population. Oral direct-acting antivirals (DAAs) for HCV treatment offer a new hope to reduce ongoing HCV transmission as well as HCV-associated burden, both inside and outside of prisons.  Yet the long-term health benefits of treating inmates, who may face re-exposure to HCV, are unknown. Our objective was to evaluate HCV treatment as prevention and how it reduces HCV-associated outcomes.

Method:

We used a validated microsimulation model that considered HCV transmission, natural history of HCV progression, treatment with oral DAAs, and simulation of prison and general population dynamics. The baseline population in the model represented the United States population as a whole in 2015, stratified by age, gender, prevalence of HCV, health states defined by METAVIR fibrosis scores, range of HCV genotype, treatment experiences, and injection drug use. We estimated the long-term disease outcomes, both inside and outside the prisons, per 10,000 prisoners with chronic hepatitis C who had in-prison access to DAAs. We compared these with outcomes if infected prisoners were released to the community without treatment, where they could transmit HCV to others. We assumed a portion of community dwelling individuals could access treatment post-release. All persons who were successfully treated, either inside or outside prisons, could re-acquire HCV. We ran our model for 30 years to estimate the long-term outcomes.

Result: Compared with no treatment, availability of DAAs for treatment per 10,000 infected prisoners would prevent 400–600 new infections; 90% of these would occur after release. In addition, availability of HCV treatment in prisons would also prevent approximately 700 cases of decompensated cirrhosis, 800 hepatocellular carcinomas, 70 liver transplantations, and 1,100 liver-related deaths. Among deaths averted, 60% would occur outside of prisons.

Conclusion:

Providing HCV treatment with oral DAAs to prisoners would reduce ongoing HCV transmission and HCV-associated diseases; the majority of the benefits would be accrued outside the prisons, in the community. If public funding for HCV elimination efforts were to focus on prisons, the greatest beneficiaries will be community healthcare systems.   Supplementing current prison budgets with extra resources would be a strategic way to improve health outcomes across the society.

See more of: ORAL ABSTRACTS: INFECTIOUS DISEASE CONTROL

See more of: 38th Annual North American Meeting of the Society for Medical Decision Making