Assessing progress towards viral hepatitis B and C elimination in prison settings in the European region

Background: In 2016, the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring and evaluation (M&E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are relatively integrated into national monitoring efforts. We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routinary sources of data. Methods: We adapted the WHO M&E framework for hepatitis elimination to the prison context. The resulting M&E framework has 49 indicators, of which 10 were defined as core. Data were sourced from available European prison surveillance systems at European level, namely: Euorpean Monitoring Centre for Drugs Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED). 
Completeness of core indicators was assessed by countries (number of countries with available indicators/reporting countries) on a scale of four values: excellent (100-76%); good (75-51%); unsatisfacotry (50-26%); poor (25-0%).
Results: In total, 36 countries in the European region provided data to either data sources for 2020. Among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment and treatment outcome. Completeness was classified as good only for HCV prevalence. For HBV, 5 core indicators out of 10 could be calculated and covered prevalence, vaccination, screening, pre-treatment assessment and treatment coverage in prison. Completeness was good or excellent for 2 indicators.
Conclusion: Availabilty of health data from prison settings is exiguous, hampering current capacity to monitor progress in the viral hepatitis elimination in prison contexts strategies and its relative contribution to global health goals achievement. A standardised M&E framework tailored to this setting is needed to foster data collection and systematic monitoring.