The International journal on drug policy · 2026
Reinfection following direct-acting antiviral therapy for hepatitis C infection among people in prison with recent injecting drug use: the SHARP-P study.
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Conway Anna, Grebely Jason, Tillakeratne Shane, Cunningham Evan B, Munyengeterwa Usai, Van Dyk Jodi, Martinello Marianne, Carson Joanne, Lafferty Lise, Bull Rowena A, Horsburgh Bethany, McGrath Colette, Brown Tracey, Treloar Carla, Amin Janaki, Degenhardt Louisa, Applegate Tanya L, Dunlop Adrian, Matthews Gail V, Dore Gregory J, Lloyd Andrew R, Hajarizadeh Behzad
Аннотация
BACKGROUND: Given sub-optimal harm reduction access, people in prison who inject drugs are at great risk of hepatitis C virus (HCV) infection, including reinfection following successful treatment. In New South Wales, Australia, prison-based opioid agonist treatment (OAT) is available, but there is no needle syringe programme. This study evaluated post-treatment HCV reinfection incidence among people in New South Wales prisons who inject drugs.
METHODS: SHARP-P was a cohort study of people with recent injecting drug use (previous six months) receiving direct-acting antiviral (DAA) treatment in New South Wales prisons (2019-21). Participants were recruited before commencing therapy and assessed every 3-6 months post-treatment for recurrent viremia. HCV genome sequencing and clinical follow-up data were used to classify recurrent viremia as: definite reinfection, possible reinfection, virological failure, and undefined. Person-time of observation was used to calculate reinfection incidence, overall and in sub-populations.
RESULTS: Of 201 participants, 154 (77%) with post-treatment follow-up were included in the analyses (median age 32 years, 20% women, 16% receiving OAT, 62% reported injecting drugs in the month before enrolment, of whom 95% shared injecting equipment in prison). Twenty-six episodes of recurrent viremia were detected, including 16 definite reinfections, three possible reinfections, one virological failure, and six undefined. During 103 person-years of follow-up, incidence of definite HCV reinfection was 15.5/100 person-years (95%CI, 9.525.3) overall, 19.4/100 person-years (95%CI, 11.2-33.4) among those injecting during follow-up, and 57.9/100 person-years (95%CI, 32.9-101.9) among those sharing injecting equipment.
CONCLUSIONS: The high HCV reinfection incidence in prisons emphasises the need to enhance prison-based harm reduction measures including access to sterile injecting equipment, currently prohibited in Australian prisons. The finding that reinfection accounts for most recurrent viremia could assist retreatment clinical decision-making in prison.
METHODS: SHARP-P was a cohort study of people with recent injecting drug use (previous six months) receiving direct-acting antiviral (DAA) treatment in New South Wales prisons (2019-21). Participants were recruited before commencing therapy and assessed every 3-6 months post-treatment for recurrent viremia. HCV genome sequencing and clinical follow-up data were used to classify recurrent viremia as: definite reinfection, possible reinfection, virological failure, and undefined. Person-time of observation was used to calculate reinfection incidence, overall and in sub-populations.
RESULTS: Of 201 participants, 154 (77%) with post-treatment follow-up were included in the analyses (median age 32 years, 20% women, 16% receiving OAT, 62% reported injecting drugs in the month before enrolment, of whom 95% shared injecting equipment in prison). Twenty-six episodes of recurrent viremia were detected, including 16 definite reinfections, three possible reinfections, one virological failure, and six undefined. During 103 person-years of follow-up, incidence of definite HCV reinfection was 15.5/100 person-years (95%CI, 9.525.3) overall, 19.4/100 person-years (95%CI, 11.2-33.4) among those injecting during follow-up, and 57.9/100 person-years (95%CI, 32.9-101.9) among those sharing injecting equipment.
CONCLUSIONS: The high HCV reinfection incidence in prisons emphasises the need to enhance prison-based harm reduction measures including access to sterile injecting equipment, currently prohibited in Australian prisons. The finding that reinfection accounts for most recurrent viremia could assist retreatment clinical decision-making in prison.