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PWE-054 Treating hepatitis C in prisoners: is it worth it?
  1. S Saksena1,
  2. A Cook1,
  3. M Hewett1,
  4. D Jones2,
  5. B Docherty2
  1. 1Department of Gastroenterology, University Hospital of North Durham, Durham, UK
  2. 2County Durham PCT, Durham Prison Services, Durham, UK

Abstract

Introduction Due to a higher prevalence of intravenous drug use among offenders, prisons may have a higher prevalence of HCV than community, managing HCV and ensuring successful therapy may be more challenging in such settings.1 Durham has one of the largest prison populations in the UK. NICE endorsed therapy with pegylated interferon and ribavarin is recommended with reported rates of sustained viral response (SVR) of 75–85% with 6 months and 40–50% with 12 months therapy for genotypes 2/3 and 1, respectively.2 A new service was set up at University Hospital of North Durham in January 2008 to improve provision of HCV care within the NHS and the local prisons with a nurse led inreach service in prisons.

Methods The aim of the study was to audit treatment outcomes of referrals to the HCV service in County Durham with current NICE guideline. Data were collected prospectively from January 08 using a computerised database.

Results There were 120 referrals from January 3008 to September 2009; at time of abstract submission, follow-up data on SVR were available for those commenced on treatment between Jan to Dec 2008, data on these 59 HCV PCR positive patients including 47 prisoners are presented. 15 prisoners were unable to complete therapy as they were lost to follow-up following transfer/release from prisons in Durham. Reasons for not treating included patient refusal in 3 and DNAs of GP referrals and prisoners transferred elsewhere prior to start of therapy in 14 (Abstract 054).

Abstract PWE-054

Results of HCV therapy

Conclusion Approximately three quarters of all HCV referrals were suitable for therapy; SVR of 100% and 86% were observed in those with genotype 2/3 and 1, respectively, who completed treatment, these outcomes are superior to those reported in NICE and were similar in prisoners and community referrals. There data suggest that while treatment outcomes for prisoners with HCV are similar to those treated in the community, the main obstacle in treating prisoners is ensuring therapy is completed as prisoners are lost to follow-up, in up to a quarter of cases due to transfers/ release. These findings indicate a need to improve the pathway for ensuring complete follow-up of this patient group.

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