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

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.