From hepatitis C infection control to elimination: the experience of prisons in Catalonia, Spain between 2020 and 2024

BACKGROUNDPrisons are key intervention sites for eliminating hepatitis C virus because people who are incarcerated have a high virus prevalence.AIMWe aimed to evaluate the effectiveness of a continuous, prison-wide hepatitis C virus elimination programme in Catalonia, Spain.METHODSWe determined hepatitis C virus prevalence among individuals entering nine prisons (2020-2024), cumulative incidence, and programme effectiveness based on annual incidence and number of direct-acting antiviral (DAA) treatments (2016-2024). Effectiveness was defined as zero incidence or hepatitis C virus RNA < 0.5% (unlikely transmission). Multivariate analysis assessed variables associated with reinfection.RESULTSOf 34,088 individuals entering prison, 93.9% were tested (29,826 males; 2,176 females), revealing 370 (1.2%) infections, with a downward trend from 2.2% in 2020 to 0.6% in 2024 (p<0.001). Analysis of 361 infections showed higher frequency in men, Spanish nationals, Barcelona prisons, people who inject drugs, and those living with HIV; 82 were reinfections. Mean time to reinfection was 1,185 ± 164 days, shorter (p = 0.001) in foreign-born individuals (730 ± 290 days); 340 (94.2%) were treated, and 334 (98.2%) sustained virologic response. Incidence remained < 0.5 per 100 person-years from 2020. At 31 December 2024, no viraemia was detected in four of the nine prisons studied.CONCLUSIONIt is possible to eliminate hepatitis C in prisons through universal screening, prompt treatment and reinfection monitoring.