HCV exposure, infection and associated risk behaviours in two maximumsecurity prisons in NSW, Australia

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1 HCV expsure, infectin and assciated risk behaviurs in tw maximumsecurity prisns in NSW, Australia Hajari B 1, Grebely J 1, Byrne M 1, Marks P 1, Butler T 1, Amin J 1, Vickerman P 2, Martin NK 2,3, McHutchisn JG 4, Brainard DM 4, Trelar C 5, Llyd AR 1, Dre GJ 1 1. The Kirby Institute, UNSW Australia, Sydney, Australia; 2. Schl f Scial and Cmmunity Medicine, University f Bristl, UK; 3. Divisin f Glbal Public Health, University f Califrnia San Dieg, CA, USA; 4. Gilead Sciences, Inc., Fster City, CA, USA; 5. Centre fr Scial Research in Health, UNSW Australia, Sydney, Australia Backgrund HCV prevalence in the prisn setting is high. Glbal (HCV Ab+): 26% Australia (HCV Ab+): 31% HCV transmissin in the prisn setting is als high due t lack r sub-ptimal cverage f HCV preventin strategies, including needle syringe prgrams (NSP), and piid substitutin treatment (OST). HCV incidence, glbal: 16/100 py HCV incidence, Australia: 6/100 py (amng thse with life-time histry f injecting drug use) Peple wh inject drugs (PWID) have high rates f imprisnment. 45% f Australian prisners reprt ever injecting drug use 2 Larney, Hepatlgy 2013; Butler 2015; Cunningham, INHSU

2 Backgrund In NSW prisns, OST and bleach-cleansing f injecting equipment is available, but nt NSP. OST and bleach-cleansing f injecting equipment in NSW prisns had n significant impact n reducing HCV incidence. 3 Butler 2015; Cunningham, INHSU 2016; Luciani, Addictin 2014 The Surveillance and Treatment f Prisners with hepatitis C A partnership prject t investigate the feasibility f HCV treatment as preventin in the prisn setting Overall aims: T evaluate the impact f rapid scale-up f DAA treatment n HCV incidence and prevalence in the prisn setting T develp a translatinal framewrk fr subsequent establishment f treatment-as-preventin prgrams in the prisn sectr M a x i m u m - s e c u r i t y p r i s n s Gulburn Crrectinal Centre, Gulburn Lithgw Crrectinal Centre, Lithgw M e d i u m - s e c u r i t y p r i s n s Outer Metrplitan Multipurpse Crrectinal Centre (OMMPCC), Sydney Dillwynia Crrectinal Centre (Wmen), Sydney 4 2

3 STP-C: Study Schedule Max. Security Start-up Crrectinal Centre 1 (Gulburn) HCV incidence and prevalence surveillance Mdelling Max. Security Crrectinal Centre 2 (Lithgw) Med. Security Crrectinal Centres Translatinal Studies Treatment scale-up HCV incidence and prevalence surveillance Mdelling Treatment scale-up HCV incidence and prevalence surveillance Mdelling Cst-effectiveness study Treatment scale-up Qualitative studies Mathematical mdelling Framewrk and tlkit 5 Methdlgy Data fr this analysis includes prisners enrlled frm tw maximum-security prisns between Octber 2014 and August At enrlment, participants received testing fr HCV Ab and RNA, and cmpleted a detailed interview, including injecting behaviurs. Objectives: T evaluate HCV expsure and infectin T assess the behaviural factrs by HCV status 6 3

4 Results: Backgrund characteristics Ttal (n=609) Gulburn (n=426) Lithgw (n=183) Age, median (IQR), year 33 (26, 43) 33 (26, 43) 32 (26, 41) Brn in Australia 510 (84%) 360 (84%) 150 (82%) Educatin level lwer than high schl Length f sentence, median (IQR), years Duratin incarcerated, median (IQR), years 218 (36%) 148 (35%) 70 (38%) 7.8 (3.0, 17.0) 1.8 (0.6, 4.2) 7.0 (2.2, 16.0) 1.6 (0.5, 4.1) 9.2 (3.7, 20.0) 2.2 (1.1, 4.4) Previusly imprisned 435 (71%) 312 (73%) 123 (67%) 7 Results: HCV status Ttal n=609 HCV Ab - n=331 (54%) HCV Ab+ n=278 (46%) HCV RNAn=105 (38%) HCV RNA+ n=173 (62%) 8 4

5 Results: HCV status HCV Ab- (nt expsed) HCV Ab+, RNA (expsed, nt infected) HCV RNA+ (infected) n=173 29% n=105 17% n=331 54% HIV Ab psitive: n=1 (<1%) HBs Ag psitive: n=9 (1%) 9 Results: Gentype and liver fibrsis HCV gentype n = 173 G1 G2/G4/G6 Nt available G3 Mixed Liver fibrsis stage (transient elastgraphy) n = 85 F0-F1 F2 F3 F4 12% 2% 3% 2% 3% 50% 24% 33% 71% 10 5

6 Percent 8/09/2016 Results: Self-reprted histry f HCV treatment HCV Ab+, HCV RNAexpsed nt infected n = 105 HCV RNA+ infected n = 173 Hx f treatment N treatment n=31 30% n=18 10% 11 Results: IDU risk behavirs by HCV status HCV Ab % 94% 74% 80% 76% HCV Ab+, RNA- HCV RNA % 61% 50 48% 47% 40 35% 30 26% % 13% 11% 7% 0 Ever IDU IDU in custdy IDU current imprisnment IDU last 6 m in prisn IDU last 1 m in prisn 12 6

7 Percent 8/09/2016 Results: IDU risk behavirs amng active PWID Thse injecting in the last mnth in prisn (n = 140) % 40% 51% 95% 72% 89% 86% 81% 81% 95% 62% 73% HCV Abn=22 HCV Ab+, RNAn=37 HCV RNA+ n= Injecting daily r mre Used a shared needle/syringe Used ther shared injecting equipment N current OST 13 Cnclusin 14 A high prprtin f participants with HCV infectin frm maximumsecurity prisns reprted injecting risk behaviurs, ptentially cntributing t HCV transmissin in the prisn. Amng ttal participants at risk f HCV, thse with previus HCV expsure and clearance were mre likely t reprt active injecting in the prisn than thse with n previus expsure, suggesting nging risk f re-infectin. Amng participants with active IDU, high risk injecting was reprted by all participants. It can translate t: High risk f transmitting HCV by thse with HCV infectin High risk f bth HCV primary and re-infectin amng susceptible individuals Increased HCV preventin strategies are needed. Surveillance f HCV incidence shuld fcus n detectin f bth HCV primary infectin and re-infectin. 7

8 Acknwledgements STP-C is supprted by Natinal Health and Medical Research Cuncil (NHMRC) Partnership Prject Grant (APP ), and Gilead Sciences, Inc. Study partners: Prtcl Steering Cmmittee: Stuart Lveday (Chair) Hepatitis NSW Greg Dre (c-pi) UNSW Australia Andrew Llyd (c-pi) UNSW Australia Jasn Grebely UNSW Australia Tny Butler UNSW Australia Marianne Byrne UNSW Australia Carla Trelar UNSW Australia Gergina Chambers UNSW Australia Lee Trevethan JH&FMHN Clette McGrath JH&FMHN Julia Bwman JH&FMHN Ry Dnnelly JH&FMHN Luke Grant Crrective Services NSW Terry Murrell Crrective Services NSW Nicky Bath NSW Health Alisn Churchill Cmmunity Restrative Centre Kate Pinnck Cmmunity Restrative Centre Mary Ellen Harrd NSW Users and AIDS Assciatin Natasha Martin University f Califrnia San Dieg Peter Vickerman University f Bristl The cntent f this presentatin are slely the respnsibility f the individual authrs and nt d nt reflect the views f NHMRC r Gilead Sciences, Inc. 15 8

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