New Model of Care Achieving Micro-Elimination of Hepatitis C in the United Kingdom's Largest Prison

Abstract

Wales aims to achieve the World Health Organisation goal of eliminating hepatitis C (HCV) as a public health threat by 2030, with micro-elimination in prisons identified as a key target. In January 2022, HMP Berwyn, the largest prison in the United Kingdom, introduced a multi-disciplinary blood borne virus (BBV) team and a streamlined testing and treatment pathway incorporating opt-out testing, peer support, point-of-care viral load testing and pharmacist-led prescribing. This service evaluation describes implementation of the pathway and its outcomes. Data relating to testing and treatment were collected between January 2023 and December 2024. In Welsh prisons micro-elimination of HCV is defined as 100% of the population being offered a test, over 90% accepting testing and over 90% of those testing positive starting treatment. When micro-elimination was first achieved in September 2023, the prison population was 2004. All prisoners had been offered HCV testing in the preceding 12 months and 1915 (95.6%) accepted testing. Twenty-seven men tested HCV PCR positive in the preceding 6 months, and 23 of 24 eligible patients (95.8%) commenced treatment. During 2023 and 2024, 85 men tested HCV PCR positive and 75 of 78 eligible patients (96%) initiated treatment. Median time from diagnosis to treatment initiation was 17 days. Testing uptake remained above 90% during the subsequent 18 months. HMP Berwyn achieved and sustained HCV micro-elimination using a multidisciplinary model that integrated testing and treatment into routine prison healthcare. This model may be transferable to other custodial settings and populations at high-risk of HCV infection.