Extremely low diagnostic yield of routine hepatitis B and human immunodeficiency virus screening among incarcerated adults treated for hepatitis C in Western Australia

Routine testing for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is recommended prior to initiating direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in Australian prisons. We evaluated the diagnostic yield of HBV and HIV screening among 713 incarcerated adults commencing DAA therapy across multiple Western Australian prisons between 2017 and 2025. The cohort had a mean age of 34.8 years and was predominantly male (81%). HBV and HIV screening outcomes were available for all participants. Only one (0.14%) participant tested positive for hepatitis B surface antigen and none for HIV. A further 12% had serological evidence of past HBV exposure. These findings confirm an extremely low yield of universal pre-treatment HBV/HIV screening in this setting. While screening remains clinically important, treatment should not be delayed while awaiting results. Parallel testing strategies may streamline care and support hepatitis C elimination efforts in custodial settings. This study represents one of the largest contemporary evaluations of HBV and HIV screening outcomes among incarcerated individuals receiving DAA therapy in Australia.