|
KMID : 1040620210270030474
|
|
Clinical and Molecular Hepatology
2021 Volume.27 No. 3 p.474 ~ p.485
|
|
|
The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients
|
|
Wong Yu Jun
Thurairajah Prem Harichander
Kumar Rahul
Fock Kwong Ming
Law Ngai Moh
Chong Sin-Yoong
Manejero Fria Gloriba
Ang Tiing-Leong
Teo Eng Kiong
Tan Jessica
|
|
|
Abstract
|
|
|
Background/Aims: Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.
Methods: In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013?2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.
Results: A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).
Conclusion: In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.
|
|
|
KEYWORD
|
|
|
Prisons, Antiviral agents, Hepatitis C, Chronic
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
    
|
|