The HIPPOCRATES Project: A Proof of Concept Promoting HCV Microelimination Strategy Plan in Prisons

Background & Aims: In the last few years we have witnessed a revolution in the treatment of hepatitis C virus (HCV) infection. With the introduction of direct-acting antiviral agents (DAA), sustained virological response (SVR) is achieved in more than 95% of the patients. The focus is now being turned on to high-risk groups, with the aim of achieving HCV elimination by 2030. Prison inmates constitute one of the high-risk groups, and they receive treatment less frequently due to barriers in access to health care. The aim of this study is to describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting. Methods: A prospective observational study was performed including all prison inmates monoinfected with HCV, from April 2017 to March 2018 in a Portuguese prison. Demographic, clinical and laboratorial data, as well as transient elastography measurements, were collected onsite by the medical team and prospectively recorded. Patients were treated with DAA according to international guidelines. SVR rates and adverse events were analyzed. Results: 67 monoinfected HCV male inmates (mean age of 42,4 ±8,1 years) were enrolled. 72% reported history of injecting drugs or tattooing, with 44% of the latter being made in prison. 78% referred alcohol consumption of more than 30 g/day. The most prevalent genotype was 1a (54%), followed by 3 (30%) 4 (9%) and 1b (8%). Pretreatment fibrosis degree was mild-to-moderate (F0-F2) in 78% and severe in 22% (F3-F4). Treatment regimens chosen were: 52% elbasvir/grazoprevir, 30% sofosbuvir/velpatasvir and 18% sofosbuvir/ledispavir. No major adverse events were observed. SVR rate was 100%. Conclusions: In a population considered hard-to-access and a cornerstone for HCV elimination, the doctors' visits to the prison setting, as well as the assisted medication administration lead to a 100% rate of SVR. Funding Statement: The authors declare: "None." Declaration of Interests: The authors declare: "None." Ethics Approval Statement: This study was conducted according to the Declaration of Helsinki. The ethical approval for this study was obtained from the Ethics Committee of Centro Hospitalar Sao Joao and Porto's correctional system. Informed consent was obtained from each patient before each treatment.