Point-of-Care Testing and Treatment of Hepatitis C Virus in Prisons: The SINTESI Project in Sicily

Abstract

Objective: To eradicate hepatitis C virus (HCV) infection among prisoners using specific models of screening and linkage to care. Patients and Methods: The Sicilian Network for Therapy, Epidemiology and Screening in Hepatology (SINTESI) runs an HCV point-of-care project in all 23 prisons in Sicily. All prisoners received information on HCV screening and the possibility of receiving treatment with direct-acting antiviral (DAA) therapy during imprisonment. HCV status was assessed by rapid oral test and immediate reflex testing for HCV-RNA by Xpert HCV Viral Load. HCV-RNA–positive subjects received DAA therapy within 72 hours of screening. Results: The project was conducted from October 18, 2021, through March 24, 2023. Among 5912 prisoners (98% of the entire prison population) informed of the screening project, 5050 (85.4%) accepted HCV testing. The mean age was 41.8 years (range, 18-86 years), and 4843 (95.9%) were males. Overall, 245 subjects (4.8%) tested positive for anti-HCV. Among 245 anti-HCV-positive prisoners, 20 (8.1%) refused the HCV-RNA test; 100 (40.9%) tested negative (80 had a previous DAA treatment) and 125 (51.1%) tested positive for HCV-RNA. Twelve (4.9%) of the latter refused treatment, whereas 113 (46.2%) started a cycle of DAA drugs during imprisonment. Of these, 99 (87.9%) completed DAA therapy, and 98 (86.7%) obtained HCV clearance. Conclusion: The findings highlight the importance of tailored interventions for high-risk populations, and the model is replicable in other regions and contexts.