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Heroin Addiction and Related Clinical Problems: 2019, 21, N1 (pages: 35 - 45)

Hepatitis C Virus (Hcv) Screening in People Who Inject Drugs (Pwid) and Prisoners - a Narrative Review of Extant Literature

Crowley D., Cullen W., Lambert J., and Van Hout M.C.

Summary: Background. Injecting drug use (IDU) is the major driver of Hepatitis C Virus (HCV) infection in European and other developed countries. People who inject drugs (PWID) and prisoners, both marginalised and underserved populations are recognised as key groups to target for HCV screening and treatment. Aim: To review the most up to date published literature on HCV screening in PWID and prisoners. Methods: Electronic data base (Medline, PubMed, Cochrane library and Embase) and relevant website search using key search terms related to the topic. Results: Data on HCV screening in these two groups is incomplete. Over half of PWID and a quarter of prisoners globally have been exposed to HCV. Multiple personal and institutional barriers, including; lack of knowledge, fear, stigma , complex testing procedures and competing priorities , have been identified to the upscaling of screening in these two groups. Focussed screening at targeted locations, increasing screening methods including the use of dried blood spot testing (DBS), peer-worker involvement and opt-out screening in prisons has the potential to enable uptake. Reflex-RNA testing streamlines identification of active infection and improves linkage to care. Supporting community linkage on prison release is critical to optimise HCV management. Active case finding in PWID and prisoners, provided within an ethical and human rights framework, increases diagnosis, assessment, and treatment, reduces transmission and is cost-effective. Conclusion: Optimising HCV screening in PWID and prisoners underpins any public and prison health strategy aimed at HCV elimination but requires political will and targeted resources to be successfully implemented.