Management of Hepatitis C in Delaware Prisons: : Approaching Microenvironmental Eradication

The management of chronic hepatitis C virus (HCV) infection has been transformed due to the arrival of HCV-specific Direct-Acting Antivirals (DAAs), which are safer, more effective, and better tolerated than the interferon-based therapies that preceded them. Compared with community healthcare systems, many prison healthcare systems have been slower to adopt the routine use of HCV DAAs despite the fact that HCV infection disproportionately affects individuals in correctional institutions. In 2015, the Delaware Department of Correction (DDOC) launched a treatment program that prioritized treatment for patients who were at greatest risk of disease complications. To date, 327/345 (95%) of eligible current HCV patients have initiated DAA therapy. A total of 196/199 (98.4%) patients who have initiated treatment and who have post-treatment data available have achieved sustained virologic response, defined as undetectable HCV viral load 12 weeks after treatment. Applying a concept of microenvironmental eradication, it can reasonably be concluded that that DDOC is approaching this benchmark with regard to chronic HCV infection and will soon enter a "maintenance phase," during which it will be feasible to treat new cases of HCV in real time. Correctional systems with significant numbers of untreated hepatitis C patients may want to consider implementing HCV treatment programs that focus on cost-effectiveness and prioritize treatment for patients who are at greatest risk of disease complications.