PT  - JOURNAL ARTICLE
AU  - Nadine Kronfli
AU  - Camille Dussault
AU  - Marina B. Klein
AU  - Bertrand Lebouché
AU  - Giada Sebastiani
AU  - Joseph Cox
TI  - The hepatitis C virus cascade of care in a Quebec provincial prison: a retrospective cohort study
AID  - 10.9778/cmajo.20190068
DP  - 2019 Oct 01
TA  - CMAJ Open
PG  - E674--E679
VI  - 7
IP  - 4
4099  - http://www.cmajopen.ca/content/7/4/E674.short
4100  - http://www.cmajopen.ca/content/7/4/E674.full
SO  - CMAJ2019 Oct 01; 7
AB  - Background: Hepatitis C virus (HCV) microelimination efforts must target people in prison; however, although some inmates may qualify for treatment in provincial prisons, it may not be routinely provided. Our aim was to characterize the cascade of HCV care in Quebec’s largest provincial prison.Methods: We conducted a retrospective study of all HCV-related laboratory tests requested at the Établissement de détention de Montréal (men’s prison with on-demand screening), between July 1, 2017, and June 30, 2018. We defined 8 HCV care cascade steps: 1) total sentenced inmates, 2) screened for HCV (via HCV antibody [HCV Ab]), 3) HCV Ab positive, 4) tested for HCV RNA, 5) HCV RNA positive, 6) linked to care, 7) HCV treatment initiated and 8) achieved sustained virologic response. We measured proportions of inmates at each step using denominator–numerator linkage. We also calculated the proportion screened among inmates with a sentence duration of at least 1 month, during which time screening should be feasible.Results: Of the 4931 sentenced inmates, 344 (7%) were screened for HCV, of whom 38 (11%) were HCV Ab positive. Thirty-five (92%) of the 38 received HCV RNA testing, which showed positivity in 16 (46%). Ten (62%) of the 16 inmates were linked to care; treatment was initiated in 3 (30%), 2 of whom (67%) achieved a sustained virologic response. Among inmates with a sentence duration of at least 1 month (n = 1972), the proportion screened increased to 17%.Interpretation: A small proportion (7%) of men at a Canadian provincial prison with on-demand HCV testing were screened, and rates of treatment initiation were low in the absence of formal HCV cure pathways. To eliminate HCV in this subpopulation, opt-out HCV testing should be considered.