Harm reduction measures for HCV prevention and treatment lacking in Europe's prisons, survey finds

Keith Alcorn
31 May 2018

Harm reduction measures for the prevention and treatment of hepatitis C in prisoners are still lacking in the majority of European countries and the lack of harm reduction will block progress towards elimination of hepatitis C, according to the findings of a survey of policy and practice in 25 countries published in the Harm Reduction Journal.

The study looked at the availability of needle and syringe programmes, opioid substitution therapy, screening for hepatitis C and treatment of hepatitis C. The study was sponsored by the European Liver Patients Association (ELPA) as part of the Hep-CORE study. Hep-CORE is a cross-sectional study of viral hepatitis policy implementation in Europe, using responses from hepatitis patient groups in 25 countries gathered in 2016 and 2017.

Prisoners have a higher prevalence of hepatitis C than the general population, both because of risk factors prior to imprisonment and risk factors in the prison environment, including sharing of injecting equipment and tattooing using unsterilised equipment.

The incidence of hepatitis C in prisoners who inject drugs while in prison is very high; a systematic review of studies of hepatitis C virus (HCV) infection in prison found that among people with a history of injecting drug use, 16 out of 100 prisoners would become infected for each year they spent in prison.

Harm reduction measures that are proven to reduce the risk of HCV infection include provision of sterile injecting equipment, opioid substitution therapy to minimise drug injecting and hepatitis C treatment to eliminate the infection and reduce the number of people who can transmit hepatitis C. Screening for hepatitis C is essential in order to raise awareness of risk and to obtain appropriate medical treatment.

The Hep-CORE study found that 16 countries reported no HCV screening policy for prisoners. Only nine European countries had identified prisoners as a population at high risk of HCV infection and a priority group for screening. Just one country, the United Kingdom, operates a universal opt-out screening programme for all prison entrants.

Access to HCV treatment in prisons is limited. Although 21 countries provide treatment to some prisoners, only five countries (Slovakia, Slovenia, Spain, Sweden and the United Kingdom) provide HCV treatment in all prisons. In other countries, treatment is not available in all prisons or information is unavailable about which prisons provide treatment, the survey found.

Needle and syringe programmes in prisons are permitted only in Romania and Spain but eleven countries offer opioid substitution therapy to prisoners, the survey found. However, in four out of eleven countries opioid substitution therapy is provided only to those people already enrolled in opioid substitution therapy programmes at the time of imprisonment, while regional variations to access exist in other countries.

“Despite the documented high prevalence of HCV in prisons, internationally agreed-upon standards and recommendations for hepatitis C testing/screening and treatment, as well as prevention, have yet to be implemented,” the authors conclude. “Prisons […] are an ideal focus for micro-elimination efforts; however, targeted goals must be set in order to achieve this.”


Bielen R et al. Harm reduction and viral hepatitis C in European prisons: a cross-sectional survey of 25 countries. Harm Reduction Journal 15 (2018), https://doi.org/10.1186/s12954-018-0230-1