Let’s End HepC: Patient advocacy for hepatitis C elimination in the prisoner’s population

The prisoners’ population represents a vulnerable segment for the hepatitis C virus (HCV) infection, constituting a major public health issue. The objective of elimination of the disease established by the World Health Organization can only be achieved by understanding the impact of public health policies (PHP) to reduce the disease prevalence in this population segment on a global scale. The LEHC project was implemented in five countries (Portugal, Spain, Austria, Bulgaria and Romania) to assess the repercussion of 24 PHP in the reduction of the HCV prevalence in five population segments (Prisoners, PWID, Blood Products, Remnant Population and Vertical Transmission). Understanding the effects of each PHP is pivotal for the countries' decision-making processes to increase efforts towards the elimination of HCV nationwide. The methodological approach followed in the LEHC tool encompassed the modelling of the hepatitis C epidemiology in the selected countries and segments of the population, utilizing Markov Chains based on the disease’s natural history and Adaptative Conjoint Analysis. This method allowed for a maximum theoretical implementation potential for every considered PHP with respect to a set of epidemiological outputs for HCV.

The estimates showed active patient advocacy for HCV lead to a considerable reduction in the prevalence of the disease for the population segment of prisoners in the selected country pool between the modelled period of 2018-2030, with a prevention of 14.986 HCV cases. The modelling of HCV epidemiology can be an important contribution for the reduction of the prevalence of the disease at a global scale, thus helping to achieve WHO’s goal for its elimination by 2030. Active and consistent patient advocacy for hepatitis C, specifically, was estimated to allow for the prevention of 14.986 HCV cases in the prisoners’ population until that point in time, demonstrating the effectiveness of the micro-segmentation strategy.