Hepatitis C treatment uptake among incarcerated people in Norway, 2018-2019

Chronic hepatitis C virus (HCV) infection is common among imprisoned people. We aimed to assess HCV treatment uptake and associated factors before and after imprisonment among incarcerated individuals with chronic HCV infection.

Newly incarcerated individuals in six Norwegian prisons were consecutively included in 2018-2019 and tested for HCV infection. The cohort was linked to national registries for HCV notification status and treatment dispensations. Treatment initiation was defined as dispensation of ≥1 pack (28 days) of HCV treatment.

Among 110 individuals with previous or current chronic HCV infection, the median age was 37 years, 79.1% male and 97.2% had ever injected drugs. Chronic HCV infection had been diagnosed in 88 persons before incarceration, of whom 34 (38.6%; 95% CI 28.4-49.6) had already initiated treatment. Among 76 with detectable HCV RNA at inclusion, 62 (81.6%; 95% CI 71.0-89.5) received treatment after incarceration, with a median time to treatment of 5.1 months. Treatment rates increased from 10.6/100 PY (95% CI 7.4-14.9) in the period before incarceration to 79.4/100 PY (95% CI 60.9-101.8) after incarceration. Following incarceration, time to treatment was shorter among individuals with sentence length ≥3 months than among those on remand or with shorter sentences (aHR 1.93; 95% CI 1.10-3.41; p < 0.001). Treatment completion was observed in 57 of 62 (91.9%) participants who initiated treatment after incarceration.

HCV treatment uptake following incarceration was high, particularly among those with long sentences. HCV testing in prison should be followed by immediate treatment initiation, regardless of incarceration status and sentence length.