HCV in prison in France, national survey 2017: fewer patients but more treatments than in 2015

Background and Aims: Prevalence of HCV infection is high among prisoners. In France, penitentiary medical units (USMP) are managed by public hospital since 1994. In 2015, a French national 2015 survey describes the state of play of diagnosis and treatment of HCV prisoners. From 2016, all the prisoners can be treated whatever their liver fibrosis is. Objective: Describe national HCV diagnostic and therapeutic practices in French prisons in 2017 and to compare with the 2015 results. Method: email survey about practices in 168 USMP. Results: 71/168 (43%) of questionnaires were usable, covering 46 % of prisoners in France. The number and prevalence (%) of HCV patients decreased from 1145 (4.3%) to 928 (2.8%); (average from 20 to 16 in each USMP) There were no significant differences in proposal and performing of HCV screening; systematic announce of HCV results increased from 72% to 79 %. HCV DBS (n/n prisoners; 54%) was possible in 18 % USMP. FIBROTEST was more frequently performed than FIBROSCAN (89%/68% vs 80%/84% in 2015). Number of on-site performed FIBROSCAN was similar. On-site hepatologist consultations decreased from 56 % to 46 % USMP with a frequency falling from 3.4 to 1.6 a month. Same proportion of USMP (67 %) introduced at least one AAD treatment in 2017, number of treated prisoners increased from 145 to 260 (+79 %) with a rate of treatment increasing from 12.7 % to 28.1 % (+126%) ; In 2017, 72 % USMP compared to 59 % in 2015 introduced DAA even if release was scheduled before the end of treatment. Weekly dispensing DAA was more frequent (27 % versus 19 % in 2015) however remained mostly daily (67 % versus 79 %). Treatment and post-release follow-up after were similar. Discussion: HCV prevalence in France decreased. HCV care in prison was more efficient in 2017 than in 2015. Considering screening, systematic announce of the results was higher. Use of FIBROSCAN* to assess hepatic fibrosis was restricted. The number and percentage of treated patients increased but, 1/3 of the USMP did not introduce any treatment during the incarceration of the prisoners. DAA dispensing surveillance remains low because of their high cost. Conclusion: Prison environment constitutes a suitable environment for vulnerable population to access to HCV treatment. However DAA access remains limited.