Trends in hepatitis C care in Canada's provincial and territorial prisons from 2020 to 2024

Background: National hepatitis C virus (HCV) elimination efforts are contingent on the provision of care in prisons. This study aimed to assess HCV care practices in Canada's provincial/territorial prisons in 2024, comparing trends from 2020 to 2024. Methods: From June 14 to October 31, 2024, one representative per prison health care team (excluding Nunavut) completed a web-based survey. The outcomes of interest were HCV screening, access to direct-acting antivirals (DAAs), linkage to care following release, and access to opioid agonist therapies (OAT) and prison-based needle and syringe programs (PNSPs). Non-nominal data were aggregated by province, and descriptive statistical analyses were used to report outcomes. Results: The survey was completed by 88/94 (94%) prisons. In total, 85 prisons offered HCV screening. On-demand (15/85; 18%), risk-based (1/85; 1%), and opt-in (9/85; 11%) screening declined since 2020, while opt-out (15/85; 18%) and combination (45/85; 53%) screening increased. Reflex RNA testing occurred in over half (46/85; 54%) of prisons. DAAs were offered in 74/88 (84%) prisons, and 65/74 (88%) provided the remainder of DAAs at release to facilitate treatment completion. In 2024, the majority (78/88; 89%) of prisons facilitated continuity of care following release. OAT was available in most prisons (83/88; 94%), and in 2024, more prisons offered OAT for people who had never been on OAT (73/83; 88%). Not a single prison had implemented PNSPs. Conclusions: While there were improvements in prison-based HCV care from 2020 to 2024, HCV care was still not equivalent to that in the community in 2024, jeopardizing HCV elimination efforts both in prisons and in surrounding communities.