Gaspar R, Liberal R, Tavares J, Morgado R, Macedo G. HIPPOCRATES® project: A proof of concept of a collaborative program for hepatitis C virus micro-elimination in a prison setting. World J Hepatol 2020; 12(12): 1314-1325 [PMID: 33442457 DOI: 10.4254/wjh.v12.i12.1314]
Corresponding Author of This Article
Rui Gaspar, MD, Doctor, Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal. ruilopesgaspar@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rui Gaspar, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
Rodrigo Liberal, Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
Jorge Tavares, Rui Morgado, Estabelecimento Prisional do Porto, Porto 4200, Portugal
Author contributions: Gaspar R and Liberal R were responsible for the study design, acquisition and interpretation of data, drafting the manuscript, and statistical analysis; Tavares J and Morgado M were responsible for the study design; Macedo G was responsible for creating the project, study design, acquisition and interpretation of data and critical revision of the manuscript for important intellectual content.
Institutional review board statement: All procedures performed were in accordance and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and ethical approval was obtained from Centro Hospitalar São João.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rui Gaspar, MD, Doctor, Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal. ruilopesgaspar@gmail.com
Received: May 25, 2020 Peer-review started: May 25, 2020 First decision: June 4, 2020 Revised: August 13, 2020 Accepted: November 4, 2020 Article in press: November 4, 2020 Published online: December 27, 2020
ARTICLE HIGHLIGHTS
Research background
Hepatitis C is now a curable infectious disease with high rates of cure, reaching almost 100% cure with the use of direct antiviral agents.
Research motivation
The World Health Organization defined the aim of achieving hepatitis C virus (HCV) elimination by 2030. Although, to achieve this ambitious goal, we have to reach difficult to access groups, as persons who inject drugs and prisoners.
Research objectives
The aim of our program was to develop a research program of management and follow-up of a cohort of HCV monoinfected patients treated with direct-acting antiviral agents in the prison setting.
Research methods
We developed a strategy where a medical team (2-3 doctors) from the hospital went to prison and was responsible for outpatient clinics, liver elastography, and give the medication on-site, increasing the access to care by avoiding any need to move the patients outside the prison.
Research results
Screening of 2451 inmates resulted in 276 prisoners (11.3%), of whom 108 prisoners mono-infected for HCV. Two patients refused to participate in the project and eight were transferred to other institution before starting the treatment. All patients completed 12 wk of treatment (100% adherence), achieving a sustained virological response (SVR) at week 12 after treatment of 99.0% (97/98).
Research conclusions
In a particularly difficult to achieve population, we achieved a SVR at week 12 after treatment of 99.0%, with 100% adherence to treatment in patients that accepted the treatment.
Research perspectives
These results show that an innovative and "in-loco" project in this special population could be the pathway to achieve HCV elimination in 2030. After this pilot project, a national program was created implementing our strategy. Therefore, currently in Portugal, every prisoner has access to treatment inside the prison.
