Feasibility of a prison-based test-and-treat model for enhancing hepatitis C care in Kedah, Malaysia

BACKGROUND: Hepatitis C virus (HCV) infection remains a public health concern, significantly affecting vulnerable populations including people who use drugs and in prisons. This study assessed the feasibility of a new prison-based test-and-treat model for HCV in two prisons in Kedah, Malaysia.

METHODS: The model was tested on participants newly admitted between June 2022 and December 2023 to one of the two selected prisons, one for pretrial detention and the other for serving sentences. It features a streamlined test-and-treat procedure within prisons, encompassing anti-HCV (exposure) testing, HCV ribonucleic acid (RNA) (current infection) testing, pretreatment assessments, and treatment initiation. The outcome assessment focused on (I) screening coverage, (II) implementation success across the HCV care cascade, ranging from anti-HCV detection, HCV RNA confirmation, treatment initiation, and completion to a sustained virological response rate and (III) practicality within resource-limited prison environments.

RESULTS: All 18,811 (100%) newly admitted participants were screened for HCV during the study period, with 4,054 (21.6%) of them testing positive for anti-HCV (HCV exposure). A total of 793 (19.6%) participants underwent HCV RNA testing, with 655 (82.6%) confirmed to have HCV infection. Those with HCV RNA test results were mainly male (98.1%), with nearly half (48.2%) aged 40-49 years. A vast majority (95.7%) reported at least one HCV risk factor, primarily injection drug use (95.2%). Of the 655 participants with a positive HCV RNA test, 648 (98.9%) completed pretreatment assessments. Antiviral treatment was initiated in 319 (49.2%) of them, with 165 (51.7%) completing the full course. Among those who completed treatment, 80 (48.5%) underwent HCV RNA testing 12 weeks after treatment, with 77 (96.3%) achieving a sustained virologic response.

CONCLUSION: This new prison-based test-and-treat model for HCV infection demonstrates promising feasibility, as indicated by high screening coverage and successful implementation across the HCV care cascade using existing resources. These findings suggest the potential for broader adoption of this model in correctional facilities. Further research is needed to improve treatment completion and address factors contributing to dropout.