Hepatitis B and C care cascade among prison inmates in North India

Abstract Background Prisons, despite having high burden of hepatitis B and C infections, lack sufficient care services towards these infections. This study aimed to describe hepatitis B and C care cascade, and identify factors influencing awareness, testing, and treatment uptake among prison inmates. Methods HIV Sentinel Surveillance (HSS) data of 2021 and 2023 from 7 central prisons in North India were analyzed. Data on socio-demographic characteristics, awareness regarding hepatitis, high risk behaviours, and ever being tested for hepatitis B virus (HBV) and hepatitis C virus (HCV) were collected. Unlinked anonymous testing of venous blood samples was done for HBV/HCV. Key cascade indicators were whether they were ever tested, aware of their positive status, and subsequently on treatment. Logistic regression was done to identify factors associated with care cascade after adjusting for confounders. Results Out of 5,599 prison inmates, 42.3% had heard of hepatitis. The testing for HBV and HCV was low at 9.4% and 19.5%, respectively. Among the total participants, 1.7% and 18.5% tested positive for HBV and HCV. Among those who tested positive, less than one-sixth knew their status correctly (HBV: 2.1%; HCV: 14.3%), of whom three-fourths were on treatment. Awareness, testing and knowing positive status of hepatitis correctly were significantly higher among people who inject drugs and those with higher levels of education. HCV treatment uptake showed an increasing trend with longer duration of stay in prison. Conclusions The gap in the care cascade was more for diagnosis than treatment initiation. Implementing universal HBV and HCV screening at prison entry may reduce morbidity and mortality due to undetected infections. Integrating hepatitis care into prison health systems is essential to improve outcomes and reduce transmission. Key messages • Implementing universal hepatitis screening at prison entry is critical to address undiagnosed infections. • Integrating hepatitis services into prison health systems will reduce transmission and improve health outcomes of prison inmates.