Hepatitis C treatment and prevention in people who inject drugs (PWID) and prisoners: A narrative review of the extant literature

Background. Hepatitis C is a curable and preventable disease. People who inject drugs (PWID) and prisoners are at-risk groups for acquisition of Hepatitis C Virus (HCV), yet treatment rates remain low. Agonist Opioid Treatment (AOT) and needle syringe programs (NSP) reduce HCV transmission, yet coverage, particularly in prisons, is inadequate. 'Treatment as prevention' is a key public health strategy to help achieve the World Health Organisation (WHO) goal of HCV elimination by 2030. Aim: To review the recent literature on HCV treatment and prevention in PWID and prisoners. Methods: Electronic data base (Medline, PubMed, Cochrane library and Embase) and key website search using search terms related to the topic. Results: HCV related disease burden in PWID and prisoners is greater than the general population, yet treatment rates remain low. Direct acting anti-virals, mobile elastography, integration of treatment into community and prison settings and less restrictive treatment guidelines have removed many treatment barriers. Treatment adherence and outcomes, among PWID (even current injectors) and prisoners are equivalent to the general population. HCV treatment in both groups is cost-effective but is dependent on up scaling treatment levels, continuing treatment on prison release and preventing re-infection. The public health strategies of treatment as prevention and micro-elimination along with adequate coverage of AOT and NSP has the potential to achieve the WHO goal of HCV elimination by 2030. Conclusion: Up-scaling HCV treatment levels and increasing AOT and NSP coverage among PWID and prisoners remains a challenge but is an essential public health strategy to reduce the increasing HCV burden.