World first trials for hepatitis C wonder drug in Sydney's maximum security jails

Source: Sydney Morning Herald 29 March 2015 Natalie O'Brien

Two of NSW's maximum security jails are the location for a world-first trial of a new wonder drug that could stop the spread of the blood-borne disease hepatitis C through the prison populations.

Prisoners at the Lithgow and Goulburn jails are being recruited to take part in the treatment program, which it is hoped will eventually rid the institutions of the disease and potentially save the lives of thousands suffering chronic infections.

About a third of all prisoners in NSW jails are infected with chronic hepatitis C, which spreads rapidly through prisons by blood-to-blood contact including sharing of needles, syringes and other drug paraphernalia, tattoo equipment and from fights.

Prisons are the perfect environment to test a public health program known as "treatment as prevention" according to the scheme's principal researchers Professor Greg Dore from the Kirby Institute at the University of NSW (UNSW) and Professor Andrew Lloyd from the Inflammation and Infection Research Centre at UNSW. Two thirds of inmates are in jail for crimes relating to injecting drug use, which accounts for the high rates of hepatitis C.

Professor Lloyd said they chose maximum security prisons for the trial because they have stable populations, making it easier to test and monitor the inmates before and after they take the drug. He said they have not seen any reluctance by prisoners to come forward and most inmates with hepatitis C were keen to be free from the virus when they are released and go home to their families.

Professor Dore said the trial, which involves inmates taking one pill a day for 12 weeks, would "help break the hep C cycle in jails".

Former inmates have spoken out about injecting illegal drugs while in prison and about how they contracted the virus.

A former inmate known as John has written about his experiences, saying he contracted hepatitis C in jail. "There was just one fit and I wanted to use and I just thought "f--- it, it's worth it". That doesn't mean I don't care about my health. I do."

In a recent drug users' newsletter, another former prisoner, Barrett wrote: "recently I shot up in jail. I had my own fit and I lent it out. Maybe I shouldn't have but maybe I wouldn't have needed it if I hadn't! I was really careful about cleaning it in Fincol [disinfectant] so I was really disappointed to find out I had hep C. 

The Surveillance and Treatment of Prisoners with Hepatitis C (SToP-C) project is a collaboration between UNSW, Corrective Services NSW, Justice Health, and Forensic Mental Health Network, community organisations representing people with hepatitis C, and the pharmaceutical company Gilead Sciences, which makes the drug. The project has also received Australian government funding through the National Health and Medical Research Council.

The current interferon-based treatment for hepatitis C causes a lot of side-effects and requires significant health care resources to manage patients through six to 12 months of treatment.

The new drug treatment is expensive at $84,000 for one person (for one pill a day, for 12 weeks). However, there are few, if any, side effects and acure rate of more than 95 per cent. Gilead Science has donated the drugs for the trial.

Professor Dore said once they have rolled out the program in the maximum security jails they will expand it to several medium security jails.

The study is expected to take five years to complete. Phase one will involve 450 prisoners in each of two maximum security facilities. For the first year, study participants will undergo blood tests to monitor their hepatitis C status and be scanned for liver disease (an outcome of chronic hepatitis C infection). They will be interviewed about their risk behaviours and attend harm reduction education sessions.

Phase two of the trial will be conducted in several medium security facilities, to assess how effective a treatment-as-prevention strategy is in transient populations that move more frequently between prison and the community.

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