Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1314
Peer-review started: May 25, 2020
First decision: June 4, 2020
Revised: August 13, 2020
Accepted: November 4, 2020
Article in press: November 4, 2020
Published online: December 27, 2020
Processing time: 205 Days and 18 Hours
Hepatitis C is now a curable infectious disease with high rates of cure, reaching almost 100% cure with the use of direct antiviral agents.
The World Health Organization defined the aim of achieving hepatitis C virus (HCV) elimination by 2030. Although, to achieve this ambitious goal, we have to reach difficult to access groups, as persons who inject drugs and prisoners.
The aim of our program was to develop a research program of management and follow-up of a cohort of HCV monoinfected patients treated with direct-acting antiviral agents in the prison setting.
We developed a strategy where a medical team (2-3 doctors) from the hospital went to prison and was responsible for outpatient clinics, liver elastography, and give the medication on-site, increasing the access to care by avoiding any need to move the patients outside the prison.
Screening of 2451 inmates resulted in 276 prisoners (11.3%), of whom 108 prisoners mono-infected for HCV. Two patients refused to participate in the project and eight were transferred to other institution before starting the treatment. All patients completed 12 wk of treatment (100% adherence), achieving a sustained virological response (SVR) at week 12 after treatment of 99.0% (97/98).
In a particularly difficult to achieve population, we achieved a SVR at week 12 after treatment of 99.0%, with 100% adherence to treatment in patients that accepted the treatment.
These results show that an innovative and "in-loco" project in this special population could be the pathway to achieve HCV elimination in 2030. After this pilot project, a national program was created implementing our strategy. Therefore, currently in Portugal, every prisoner has access to treatment inside the prison.