Hepatitis B virus (HBV) and hepatitis C virus (HCV) are spread through contact with infected body fluids or blood products. These viruses can lead to acute and chronic hepatitis infection, varying from a mild illness to a serious, lifelong illness and death resulting in cirrhosis and predisposing to hepatocellular carcinoma (HCC). Most people with acute HBV or HCV infection do not have any symptoms. Those who develop chronic infection are often asymptomatic until decades after infection when symptoms can develop serious liver damage.
A vaccine is currently available only for HBV. Hepatitis B vaccination programmes are reported to exist in prisons in 16 countries in Europe.
New effective therapies are now available, but ensuring that those infected have access to them remains a challenge. The revolutionized treatment options of HCV provide is a substantial increased importance of treating HCV an any stage (of the disease), at any opportunity (via targeted screenings or other moments) and in any setting (in the community as well as in prison settings). Prisons and drug treatment services are important for identifying those with HCV infection.
The elimination of hepatitis as a public health threat by 2030 — namely a 90% reduction in new infections and a cut in mortality of 65% over the 15-year period leading up to 2030 — are core targets of the first Global health sector strategy on viral hepatitis 2016–2021, endorsed by the World Health Assembly in 2016. See: http://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf;jsessionid=599B7BF9DD0379CBC9E2CF6D0FD7724A?sequence=1
There is in increases European Union’s commitment to eliminate the hepatitis C virus. This is reflected in recent documents:
Currently provision of hepatitis C treatment in prisons is only reported in 11 countries. Barriers in the enabling treatment with the new generation of medication (oral medication, brief treatment duration, little-to-no side effects and very high curation rates) are numerous: varying from inadequate health staff capacity, insufficient referral schemes with hospitals and inadequate knowledge among staff and inmates. Up top of that, the financial implications of a HCV treatment are a burden for many prison systems, as health care finances are often the responsibility of the prison system.
Barriers in treatment: the community perspective
People in prisons face many difficulties hurdles to get access to effective HCV treatment and care. A report from EATG (European Aids treatment Group) provides overview of challenges and barries in order to better understand and document challenges and ways to enhance access to HCV related services in prison. The report is a community-based overview ATG and local civil society partners:
- providers an overview of the HCV situation in prisons in 53 countries (in WHO Europe)
- examines the situation in 6 countries from the WHO Europe region, namely Bulgaria, Finland, Italy, Kazakhstan, Moldova and Portugal.
In a recent systematic review of EU/EEA literature coordinated by ECDC, representative prevalence estimates for HBV and HCV in people in prison were only available for 11 countries. Ireland (HBV prevalence 0.3%), Bulgaria (HBV prevalence 25.2%), Hungary (HCV prevalence 4.9%) and Luxembourg (HCV prevalence 86.3%) were at the extreme ends of the spectrum. Most of the reported values were higher than in the general population . According to a review on the global burden of communicable diseases among people in prison, HBV and HCV prevalence in western Europe was estimated at 2.4% (95% CI 1.6–3.3) and 15.5% (12.2–19.1), respectively.
A recent study on the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoner, descibed the state of play regarding global prison health, challenges and opportunities.
When considering only PWID in prison, national HCV estimates were largely above 40%. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The report concludes that : “The most effective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.”
In a 2016 ECDC survey on HBV and HCV testing policies and practices in the EU/EEA, the majority of responding countries (11 countries) stated that HBV and HCV testing was offered on the basis of risk factors or medical reasons during prison stay; 21% (4 countries) said testing was offered at entry. Some countries had different testing practices at different correctional facilities. The remaining countries did not offer testing (1 country) or reported ‘unknown’.
European Centre for Disease Prevention and Control. Hepatitis B and C testing activities, needs, and priorities in the EU/EEA. Stockholm: ECDC; 2016 [unpublished].