Impact of the removal of treatment barriers on the microelimination of chronic hepatitis C in Slovak prisons: experience from real-life settings.

AIM OF THE STUDY: To evaluate the real-life experience of microelimination of chronic hepatitis C in Slovak prisons. We assessed the impact of removing treatment restrictions on the number of treated patients and the time from diagnosis to treatment initiation.

MATERIAL AND

METHODS

A retrospective analysis was conducted on 205 incarcerated patients diagnosed with chronic hepatitis C between 2018 and 2024 in five prisons in Eastern Slovakia. We compared patient data before and after the removal of treatment indication restrictions.

RESULTS

Of the total of 205 patients, 94.1% (n = 193) were men. A history of intravenous drug use was reported by 93.7% of patients. Liver fibrosis stage F0-F1 had been confirmed in 74.9% and liver cirrhosis in 5.8% of patients. Additionally, liver cirrhosis was significantly associated with older age (p < 0.0005). The most common HCV genotypes were 3a (30.7%), 1a (23.4%) and 1b (21.5%). Following the complete removal of treatment restrictions in March 2024, the number of treated patients in 2024 increased more than threefold compared to 2023 and fourfold compared to the previous annual average. The time from diagnosis to treatment initiation was significantly reduced from 325 days to 91 days (p < 0.0005). Among treated patients, 98.2% achieved an end-of-treatment response (ETR), and 98.4% achieved a sustained virological response (SVR).

CONCLUSIONS

The removal of treatment restrictions significantly improved access to therapy for incarcerated patients with HCV. Prisons provide a controlled setting for microelimination efforts, and expanding treatment in this population could contribute to broader national HCV elimination goals.