Policy changes in opioid agonist therapy and impacts on HIV and hepatitis C prevention in Canadian federal prisons

The Canadian federal prison system has implemented a successful prevention-first model for people who use drugs, including all available opioid agonist therapies (OAT), prison needle and syringe programs, and treatment-as-prevention for HIV and hepatitis C virus (HCV). These strategies have contributed to sustained low prevalence of HIV (0.7%) and chronic HCV (3.6%).1 This model has been viewed as a global benchmark for integrated HIV and HCV prevention and treatment in carceral settings.