Abstract # FRI-186 Study Aims & Results: Approximately 1/3 of people infected with hepatitis C in the United States pass through the jail and prison system each year.
Study Aims and Results: This abstract is about treating prisoners with the aid of telemedicine. Although prisons would be a perfect place to test and treat people with hepatitis C there are many barriers to treating people in prisons such as the cost of HCV medications and lack of medical providers available to provide care and treatment for the thousands of hepatitis C positive persons in prisons.
Project Echo (Extension for Community Health Outcomes) model has been providing telemedicine to people with hepatitis C and other conditions for more than a decade. It is the basis for this study that took place in New Mexico. New Mexico has a prevalence of 43% of hepatitis C on intake into the state prison system. Project ECHO uses multipoint videoconferencing to guide New Mexico Correction medical providers to treat inmates with hepatitis C.
Fifty-six TeleECHO clinics were held with 115 patients (96% male; 57% genotype 1; 39% genotype 3; 4 % genotype other). By October 31, 2016 –77 patients started treatment and 56 patients completed treatment with post-treatment follow-up. The average age was 49yo; 82% had cirrhosis. The reason for treatment in the non-cirrhotic patients was coinfection with HIV/HCV coinfection.
Treatment included Harvoni or Zepatier for genotype 1 and daclatasvir plus sofosbuvir plus ribavirin for genotype 3.
Conclusion: The cure rates for genotype 1 was 91%; 89% for genotype 3. In the 5 patients who were not cured three relapsed while on treatment, one patient died, and one patient was re-infected, 1 patient relapsed 12 weeks post-treatment with a different genotype.
Editorial Comments: I would like to see this study replicated in other prisons. It seems to be a good model that can be effectively replicated.
Eliminating hepatitis C means that we have to treat and cure everyone with hepatitis C including prisoners. Prison is an optimal place to treat inmates and telemedicine can help achieve this goal. Releasing prisoners cured of hepatitis C into the general population means that we can stop the spread of hepatitis C. It is a public health issue and a humane one.
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