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. 2019 Dec 10;2(4):171–183. doi: 10.3138/canlivj.2019-0007

Hepatitis C virus (HCV) care in Canadian correctional facilities: Where are we and where do we need to be?

Nadine Kronfli 1,✉, Jane A Buxton 2, Lindsay Jennings 3, Fiona Kouyoumdjian 4,5, Alexander Wong 6
PMCID: PMC9202815  PMID: 35992759

Abstract

Approximately 25% of people in Canadian correctional facilities have been previously exposed to hepatitis C virus (HCV). Despite being a high-prevalence setting, most Canadian prisons have thus far failed to engage the majority of those with chronic HCV infection in care. Several factors, including the lack of systematic screening programs, lack of on-site and trained health care personnel to improve access to care and treatment during incarceration, and the absence of standardized procedures needed to facilitate linkage to care following release likely contribute to poor engagement along the HCV care cascade for people in prison. HCV screening and engagement in care for people in prison can be improved through the implementation of universal opt-out screening upon admission and consideration of multidisciplinary care models for the provision of care. As well, the dissemination of prison-based needle and syringe programs to avert new HCV infections and re-infections should be considered. To meet the World Health Organization (WHO) 2030 HCV elimination goals, engaging researchers, clinicians and other health care providers, policy makers, correctional officials, and members of community in dialogue will be an essential first step going forward.

Keywords: harm reduction, HCV micro-elimination, hepatitis C virus, linkage, people in prison, screening, treatment

Introduction

With the advent of all oral short-course and highly effective direct-acting antiviral (DAA) therapy, the World Health Organization (WHO) goal of reducing global hepatitis C virus (HCV) infections by 90% by 2030 may be feasible (1). To reduce liver-related morbidity and mortality, treatment in Canada has thus far focused on individuals with advanced liver disease (2); however, Canada is currently not on track to accomplish the WHO elimination goals (3). To achieve the WHO elimination goals, prioritizing high-prevalence and -incidence sub-populations who drive the HCV epidemic in Canada, such as people in prison, should be the major focus going forward. As articulated by the WHO, ‘The state has a special duty of care for those in places of detention which should cover safety, basic needs and recognition of human rights, including the right to health’ (4). To make progress, we must involve researchers, clinicians and other health care professionals, policy makers, and members of community. As a joint effort is required, so too reflects this narrative review, incorporating perspectives from Canadian clinician-scientists and individuals with lived experience on the current realities, challenges, and opportunities for equitable access to HCV prevention and care in Canadian correctional facilities.

Burden of HCV in Canadian Correctional Facilities

There are two types of correctional facilities in Canada: federal and provincial/territorial. Federal correctional facilities hold people who have been sentenced to time in custody of 2 years or more, while provincial correctional facilities hold people who have been sentenced to less than 2 years in custody or who are held while awaiting trial or sentencing (remand) (5). Most recent data from 2015/2016 indicate that there were 43 federal and 173 provincial/territorial prisons in Canada (6,7), and 201,189 admissions to provincial/territorial custody and 7,618 admissions to federal custody (5). In 2011, the Public Health Agency of Canada (PHAC) estimated that ~25% of persons in federal or provincial/territorial custody were HCV antibody–positive (8), meaning that exposure to HCV is approximately 40-fold higher among persons in custody compared with the general Canadian population (8,9). The high prevalence of HCV in people in prisons is undoubtedly driven by the criminalization of injection drug use, which leads to the over-representation of people who inject drugs and with substance use disorders in prison, and with risk behaviours such as needle sharing in prison and in the community (10–14) in the context of limited access to harm reduction and substance use disorder treatment in prison. While the Correctional Service of Canada (CSC) recently prioritized the estimated 2,700 people with chronic HCV in federal custody for treatment in 2017/2018 (15), the same commitment to the 4,380 people living with chronic HCV in provincial/territorial prisons each day has not been made (16). Substantial challenges to treatment in provincial/territorial facilities are the short median lengths of stay of incarceration, with more than one-third of admissions to provincial/territorial custody lasting 1 week or less and more than half lasting less than 1 month (5), and the uncertainty regarding the length of stay and date of release, which reflect the types of charges and criminal justice system processes. A recent Canadian study found that HIV-HCV co-infected persons with a history of incarceration were 30% less likely to access treatment even in the DAA era (17), a proportion that is expected to be much higher among HCV-monoinfected persons given the lack of HIV care engagement. Further, several recent modelling studies have confirmed the negative impact of incarceration on fuelling HCV transmission both during incarceration and following release (18–20). Therefore, while people in prison remain disproportionately affected by HCV in Canada, to achieve micro-elimination in this sub-population, concerted efforts are required to improve engagement along the entire HCV care cascade both during and following incarceration.

HCV screening in Canadian correctional facilities

Admission to correctional facilities can provide an important opportunity to identify HCV cases through screening and initiate engagement along the HCV care cascade (21). Just as discourse regarding HIV has shifted to include a population health perspective on identifying and treating individuals to prevent ongoing transmission, a similar approach may be appropriate for HCV to meet the WHO elimination goals (22). Informed by available evidence, the Canadian Task Force on Preventive Health Care, the Canadian Association for the Study of the Liver, and the WHO have recommended HCV screening for all people who experience imprisonment (23–25). This is particularly reasonable given that a sizable proportion of incarcerated individuals are unaware of their status (26). Despite this, universal screening programs are rare in Canadian correctional facilities. For example, while federal correctional facilities offer opt-in testing routinely on admission, except for British Columbia, the majority of provincial and territorial correctional facilities provide testing only upon request.

The timing of testing, the service delivery model, and the type of test are all important factors in optimizing screening participation. In two studies, screening rates were highest on the day after admission compared with at the time of admission or 1 week thereafter (27,28), and engaging patients in care may be more feasible if screening is done prior to release (29). On-site nurse-led screening has been shown to be effective (30); HCV testing rates increased from 13.0% to 25.4% with the implementation of a public health nurse-run clinic in three Australian prisons (31). There is limited evidence regarding whether the availability of point-of-care (POC) testing in prisons improves screening; however, a pilot study in Rhode Island demonstrated that POC HCV testing was feasible and acceptable (32). Evidence is mixed regarding whether dried blood spot (DBS) testing in correctional facilities improves screening rates (33,34); DBS testing may itself require a package of interventions to be effective (35,36). The Xpert HCV viral load finger-stick POC assay, although not yet approved in Canada, could offer several advantages in prison settings (37), including the ability to diagnose active HCV infection in a single visit, with a turnaround time of 1 hour. An equally sensitive and specific screening test approved in Canada in January 2017 is the OraQuick HCV finger prick rapid antibody test, with a turnaround time of 20 minutes (38). A pilot study is currently underway to evaluate its acceptability at the largest provincial prison in Quebec.

Universal screening for HCV among people in prison would improve testing rates and case identification and would be cost-effective if linked with treatment. A large study in the Philadelphia prison system found that risk-based screening identified only about one-fifth of people with HCV infection, suggesting that universal screening would be more appropriate (39). A United Kingdom (UK) modelling study determined that DBS testing on prison entry would be cost-effective at a threshold of £20,000 ($34,000 CAD) per quality-adjusted life year (QALY) gained only if over 40% of people were linked to treatment (40). Further research supports that increased testing rates, such as through an opt-out system, and use of shorter-course direct-acting antivirals would be cost-effective at a threshold of £20,000 ($34,000 CAD) per QALY (41). A US modelling study found that universal opt-out screening in American prisons would be highly cost-effective and would reduce HCV transmission and HCV-associated diseases, primarily in the community, with incremental cost-effectiveness ratios (ICERs) ranging from $20,600 to $29,200 per QALY (21). Therefore, greater reductions in HCV transmission would be expected if opt-out screening were linked with treatment.

HCV treatment in Canadian correctional facilities

There are major disparities in the provision of HCV care in federal and provincial/territorial prisons. As previously mentioned, treatment of all people with chronic HCV in federal prisons has been implemented in Canada; however, the number of people who have been treated and cured to date remains unknown. Policy and programmatic support for treatment initiation and access varies across provincial and territorial jurisdictions. Any efforts to improve access to HCV treatment in provincial/territorial prisons must remain cognizant that a minority of people incarcerated will be in custody long enough to complete treatment during incarceration. This reality has important implications for the provision of HCV care in provincial/territorial prisons and argues for strengthening linkage to care strategies following release.

The case to strengthen linkage to care for people in provincial/territorial prisons following release is based on several arguments. First, the short incarceration times (median: 28 days) and associated high turnover rates make treatment initiation in custody with linkage to care after release or linkage to care after release for treatment initiation more likely than the completion of treatment in custody. In fact, a study performed in the pre-DAA era showed that HCV cure rates were substantially lower among individuals who were transferred (59%) or released (45%) during treatment compared with those who completed treatment in prison (74%), underscoring the importance of linkage post-release (42). Second, despite negotiations by the pan-Canadian Pharmaceutical Alliance that resulted in price reductions, the cost of DAAs remains very high, and may not be feasible with provincial prisons’ budgets (43). Third, linkage to care has broader health impacts during the precarious early weeks following release (44–46), and linkage with primary care could address some of the competing priorities that may interfere with ongoing HCV care (e.g., housing status, management of substance use disorders, mental health issues). Fourth, linkage to care is often the rate-limiting step to HCV care for recently released inmates (47); however, once linked, up to two-thirds of former inmates initiate treatment (48,49). Once linkage and subsequent treatment uptake occurs, modelling studies have shown that there is an overall reduction in HCV incidence and prevalence among all people who inject drugs, including those incarcerated and in the community, suggesting both an individual- and population-level impact (19). Thus, the optimal HCV “micro-elimination” strategy for the majority of people in provincial/territorial prisons may be to optimize linkage to care following release.

US studies demonstrate that fewer than one in 10 people who experienced incarceration is linked to HCV care following release (48,49), indicating that there may be an important role for greater emphasis on linkage and supports for linkage such as peer navigation. Peer navigation has been shown to improve linkage to HIV care for released inmates (50–53), and is recommended by the US Centers for Disease Control and Prevention (CDC) and, in 2018, by the Canadian AIDS Treatment Information Exchange as an effective intervention for enhancing patient engagement along the HIV cascade of care (54,55). Few peer navigation models have evaluated linkage to HCV care for released inmates. One such model was the transitional care coordination program in New York City jails; however, only 33% of released inmates were linked within a median time of 31 days (56). Given the challenges with treatment completion in provincial/territorial prisons, research evaluating linkage to HCV care models is warranted. A study is currently underway at Bordeaux prison, the largest provincial prison in Quebec, to determine the effectiveness of a multidisciplinary care team including peer navigation, on linkage to HCV care following release.

Once linkage to HCV care programs is strengthened, treatment can be considered for all people in provincial/territorial facilities. In the meantime, 10% of persons released from provincial/territorial correctional facilities have a length of stay in custody greater than 6 months. As has been successfully done in the United States, Iceland, Australia, and Spain, individuals in custody long enough to complete a course of DAAs should be considered for treatment during incarceration (47,57–59). This may represent a small but important step in HCV elimination in Canadian correctional facilities.

Novel models of HCV care

Due to short incarceration times, frequent prison transfers, and unplanned releases, persons in provincial prisons require accelerated pre-treatment evaluations to expedite HCV treatment initiation. Same-day diagnosis and treatment, referred to as test and treat, are now possible with recent developments in POC diagnostics and the availability of pan-genotypic regimens, many of which are now approved by Health Canada (24,60,61). However, rapid initiation of therapy is not possible unless the need for HCV genotyping is removed; in almost all provinces, a genotype remains a requirement for the reimbursement of DAAs. Furthermore, while few correctional facilities have consistent access to portable transient elastography, others rely simply on non-invasive biomarkers for determination of fibrosis staging (62)—the latter of which may be a more pragmatic option for correctional facilities.

Given the short lengths of incarceration in provincial correctional settings, not only should the time to diagnosis and treatment initiation be reduced, but the possibility of shortening the overall treatment duration should be explored. Various clinical trials have studied the feasibility of treatment durations of 4 to 6 weeks (63–67) with generally disappointing results. However, in one promising but small study, 6 weeks of combination therapy with sofosbuvir/velpatasvir/voxilaprevir cured 14 of 15 treatment-naïve genotype 1 individuals with no evidence of cirrhosis (68). Further studies are required to determine whether short-duration therapy is both safe and feasible, and can ultimately be used in correctional settings.

Increasing evidence is emerging on the role of task-shifting to non-specialist providers for the provision of HCV care. A recent study in Washington, DC, showed no difference in sustained virologic response (SVR) rates among individuals treated by specialists versus primary care providers (69). Australia was one of the first countries to employ nurse-led models of care in the interferon era with success (70), which they have now successfully implemented in four New South Wales correctional centres (the SToP-C study) (71). A needs assessment from the same Australian group underscored the importance of nurses with expertise in managing viral hepatitis in improving prison hepatitis services (72). Task-shifting may also have the added advantage of reducing associated costs relative to traditional specialist care.

Telemedicine, which refers to the process of connecting patients to physicians via videoconference, may also facilitate timely access to HCV care and reduce transportation costs between correctional facilities and referral centres for people in prison. Telemedicine has already been used successfully to manage HCV in the Canadian context (73). A similar approach could be employed in correctional settings, particularly for those with challenging geographical access to health care centres. Exceptions could be made for individuals with cirrhosis or HIV-HCV co-infection where an expert evaluation would be considered necessary. The JailFree-C Program, which uses telemedicine in El Dueso prison in Cantabria, Spain, has shown substantial cost-savings primarily in indirect patient transfers (74). A similar method to employ telemedicine involves liaising prison-based primary care providers interested in managing HCV with specialist providers who could provide advice and mentorship. The success of this Extension for Community Healthcare Outcomes (ECHO) model in the management of HCV was first described in 2011 (75) and continues to be used today in a variety of settings including correctional facilities (74). Implementation of this model may be of benefit in correctional facilities in Canada.

Harm reduction in Canadian correctional facilities

People in prisons are frequently incarcerated for crimes related to drugs and, therefore, the prevalence of substance use is higher in people in prison than in the general population (10,11,76). Although people in prison may inject less frequently compared with when in the community (77), the prison injection environment is known to be riskier (78). Former inmates in Ontario reported frequent equipment sharing (79), and the organization of illegal prison economies around the importation, sale, and use of needles and syringes (80).

Harm reduction aims to reduce the negative consequences associated with high-risk activities through policies, programs, and strategies. The 2003 WHO Moscow Declaration states that ‘Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.’ (81 p2). The 2014 WHO Prisons and Health report states that ‘Prison services have a responsibility to ensure that prisoners are not exposed to hazards likely to injure their health’ (4 p1). Despite this, the adequate provision of sterile needles, syringes, and other paraphernalia, known to reduce HCV transmission, particularly when combined with opioid agonist therapy (82), are not routinely available in Canadian correctional facilities.

Currently, most correctional institutions in Canada only provide bleach to reduce HCV transmission through injection (83). However, PHAC concluded that bleach disinfection offers little benefit to prevent HCV transmission among people who inject drugs (84). Thus, despite numerous studies confirming prisons as high-risk environments for HCV transmission (18–20), and WHO declarations expressing the need for equivalency of health care and safety for people in prison, prison-based needle and syringe programs (PNSPs) are largely unavailable in Canada.

The United Nations Office on Drugs and Crime provides compelling evidence for PNSPs as effective harm reduction interventions (85). Despite major concerns expressed by prison officials, a recent meta-analysis of PNSPs showed no increase in drug consumption or injection following implementation, and improved institutional safety for both staff and prisoners (86). Also, acceptance and support for PNSPs by trained prison staff was derived shortly after implementation (86). In 2016, 246 organizations signed a statement acknowledging ‘the overwhelming evidence supporting PNSPs in prisons’ and recognized the urgent need for their dissemination in Canada (87 p1). One small step forward was the announcement by CSC in May 2018 that a pilot Prison Needle Exchange Program in two federal institutions was being introduced to give inmates access to clean needles (88). We await the outcome of this program mindful that participation in PNSPs has been classically hindered by the lack of guaranteed confidentiality (89).

Opioid agonist treatment (OAT) is another evidence-based harm reduction measure (90,91). Since 2001, federal inmates have had access to methadone maintenance treatment (MMT) programs (92,93). MMT programs aimed to reduce the transmission of blood-borne infections by minimizing the adverse physical, psychological, social and criminal impacts associated with opioid use (94). In 2008, MMT programs were replaced by opioid substitution therapy (OST) programs to include suboxone as a treatment option (95). Consequently, uptake of suboxone by people incarcerated in federal prisons has increased over time (93). Access to OAT in Canadian provincial prisons is variable as each province has unique delivery methods, policies and monitoring (96). Currently, OAT is provided to all individuals admitted to provincial prisons on methadone (96).

Finally, HCV may also be transmitted by unsafe tattooing practices in prisons (97). In 2005, a safer tattooing initiative was implemented by CSC in six federal institutions. Despite an evaluation reporting enhanced knowledge and awareness among staff and inmates about blood-borne infectious disease prevention and control practices and the potential to reduce harm and enhance the health and safety of staff and inmates, the program was terminated in 2007 by the federal government (98). No similar initiatives have since been attempted in Canada.

The importance of community involvement

Improving collaboration with community organizations is essential for developing programs and policies to support HCV care cascade engagement for people who experience incarceration, while in custody and in the community after release. Effective collaboration with stakeholders could support the development of acceptable and effective health promotion efforts and programs, reduce HCV-related stigma among prison personnel and inmates, and share the burden of costs and programming between correctional authorities and community-based health care.

In particular, the stories of people with lived experience of imprisonment elucidate the diverse and substantial challenges with respect to health and access to health care including prevention and care for HCV, and underscore the need to provide access to HCV care as a right, as any individual, incarcerated or not, deserves to be considered for cure. This is illustrated by the following personal reflection:

When I reflect on my experience of being homeless, struggling with substance use, and being a frequent flyer, or visitor, within our provincial jail system, many overwhelming feelings arise around the lack of control I had with my emotional and physical health. The first time I was ever admitted into a jail, I was placed on “head watch”. I woke up in a cell with no understanding of why I was there, what my charges were, or why I had two black eyes. There was no follow-up from any health care staff or social workers regarding my head injury. I was left no other choice but to adapt quickly to my surroundings and find direction from my fellow prisoners on how to survive jail life, and how to access supports while incarcerated.

Once I became “comfortable” within the jail setting, I decided to have some of my health concerns addressed, assuming this would be a perfect time to deal with my health. I had a little more structure while being incarcerated than I did when I was living on the streets, as I was not busy trying to find my next meal or where to safely rest my head.

To see a doctor inside, I had to submit written requests, outlining my health care concerns. At first, I was not comfortable with putting some of my health requests on a small piece of paper that offered no confidentiality, and every opportunity for correctional officers to know (and possibly judge) me based on my health issues. Having to go through this process and have no confirmation of seeing a doctor, was very foreign to me. With my frequent visits in and out of the jail system, I started to realize that there was no guarantee of seeing a doctor, and, as a prisoner, if I developed a reputation for complaining about the lack of medical attention that I was receiving, this could impact the way that I was treated by health care staff.

When it came to seeking assistance around my mental health issues, the opportunities I had were very limited. There were not enough therapists or other staff available to respond to the number of requests for mental health support. I remember sitting in my cell ruminating over my fears about my health, and why it was so difficult to access any health care while inside. I just needed help.

Conclusions

While HCV elimination should be prioritized for people in prison, there remain large gaps in the current realities and the much-needed Canadian response. An evidence-based approach to HCV micro-elimination would entail systematic screening of all inmates, enhanced treatment and linkage to care programs, and the expansion of prison-based needle and syringe exchange programs and OAT options, guided and supported in consultation with community. Prison settings remain unique environments for the initiation of HCV care, and failing to advance prevention and treatment programs would represent missed opportunities for HCV elimination.

Acknowledgments:

This article is part of a special topic series commissioned by the Canadian Network on Hepatitis C (CanHepC). CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (NHC-142832) and the Public Health Agency of Canada.

Ethics Approval:

N/A

Informed Consent:

N/A

Registry and Registration No. of The Study/ Trial:

N/A

Funding:

No funding was received for this work.

Disclosures:

The authors have nothing to disclose.

Peer Review:

This article has been peer reviewed.

References

  1. World Health Organization. Combating hepatitis B and C to reach elimination by 2030. Advocacy Brief. Geneva: WHO; 2016. http://www.who.int/hepatitis/publications/hep-elimination-by-2030-brief/en/ (December 18, 2018). [Google Scholar]
  2. Marshall AD, Saeed S, Barrett L, et al. Restrictions for reimbursement of direct-acting antiviral treatment for hepatitis C virus infection in Canada: a descriptive study. CMAJ Open. 2016;4(4):E605–14. 10.9778/cmajo.20160008. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Hill AM, Nath S, Simmons B. The road to elimination of hepatitis C: analysis of cures versus new infections in 91 countries. J Virus Erad. 2017;3(3):117–23. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. World Health Organization. Prisons and health. Enggist S, Moller L, Galea G, Udesen C, eds. Copenhagen: WHO; 2014. http://www.euro.who.int/__data/assets/pdf_file/0005/249188/Prisons-and-Health.pdf (December 18, 2018). [Google Scholar]
  5. Reitano J. Adult correctional statistics in Canada, 2015/2016 [Internet] Catalogue no. 85–002–X. Ottawa: Canadian Centre for Justice Statistics. Statistics Canada; 2017. http://www.statcan.gc.ca/pub/85-002-x/2017001/article/14700-eng.pdf (December 18, 2018). [Google Scholar]
  6. Correctional Service Canada. Facilities & securities [Internet]. Ottawa: Correctional Service Canada; c2018. [updated 2018 Nov 7]. http://www.csc-scc.gc.ca/facilities-and-security/index-eng.shtml (December 18, 2018). [Google Scholar]
  7. World Prison Brief. World prison brief data – North America, Canada, overview. London, UK: Birkbeck University of London; 2018. http://www.prisonstudies.org/country/canada (January 7, 2018). [Google Scholar]
  8. Trubnikov M, Yan P, Archibald C. Estimated prevalence of hepatitis C virus infection in Canada, 2011. CCDR: Volume 40-19, December 18, 2014. Ottawa: Public Health Agency of Canada; 2014. http://www.phacaspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-19/surveillance-b-eng.php (December 18, 2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Challacombe L. The epidemiology of hepatitis C in Canada [Internet]. Toronto: CATIE; 2017. http://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hepatitis-c-canada (December 18, 2018). [Google Scholar]
  10. Buxton JA, Rothon D, Durigon M, et al. Hepatitis C and HIV prevalence using oral mucosal transudate, and reported drug use and sexual behaviours of youth in custody in British Columbia. Can J Public Health. 2009;100(2):121–4. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Farrell S, Ross J, Ternes M, Kunic D. Prevalence of injection drug use among male offenders. Ottawa: Correctional Service Canada; 2010. http://www.csc-scc.gc.ca/research/005008-rs10-02-eng.shtml (December 18, 2018). [Google Scholar]
  12. Gagnon H, Godin G, Alary M, Lambert G, Lambert LD, Landry S. Prison inmates’ intention to demand that bleach be used for cleaning tattooing and piercing equipment. Can J Public Health. 2007;98(4):297–300. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Poulin C, Alary M, Lambert G, et al. Prevalence of HIV and hepatitis C virus infections among inmates of Quebec provincial prisons. CMAJ. 2007;177(3):252–6. 10.1503/cmaj.060760. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Thompson J, Zakaria D, Grant B. Aboriginal men: a summary of the findings of the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey. Research report R-237. Ottawa: Correctional Service Canada; 2011. http://www.csc-scc.gc.ca/research/005008-0237-eng.shtml (December 18, 2018). [Google Scholar]
  15. Webster P. Dramatic budget increase for hepatitis treatment in federal prisons. CMAJ. 2017;189(32):E1052. 10.1503/cmaj.1095468. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kronfli N, Cox J. Care for people with hepatitis C in provincial and territorial prisons. CMAJ. 2018;190(4):E93–4. 10.1503/cmaj.171142. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kronfli N, Nitulescu R, Cox J, et al. Previous incarceration impacts access to hepatitis C virus (HCV) treatment among HIV-HCV co-infected patients in Canada. J Int AIDS Soc. 2018;21(11):e25197. 10.1002/jia2.25197. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Altice FL, Azbel L, Stone J, et al. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia. Lancet. 2016;388(10050):1228–48. 10.1016/S0140-6736(16)30856-X. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Stone J, Martin NK, Hickman M, et al. Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland. Addiction. 2017;112(7):1302–14. 10.1111/add.13783. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Stone J, Fraser H, Lim AG, et al. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet ID. 2018;18(12):1397–409. 10.1016/S1473-3099(18)30469-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. He T, Li K, Roberts MS, et al. Prevention of hepatitis C by screening and treatment in U.S. prisons. Ann Intern Med. 2016;164(2):84–92. 10.7326/M15-0617. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. World Health Organization. Global health sector strategy on viral hepatitis 2016–2021. Geneva: WHO; 2016. https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ (December 10, 2018). [Google Scholar]
  23. Grad R, Thombs BD, Tonelli M, et al. Recommendations on hepatitis C screening for adults. CMAJ. 2017;189(16):E594–604. 10.1503/cmaj.161521. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Shah H, Bilodeau M, Burak KW, et al. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ. 2018;190(22):E677–87. 10.1503/cmaj.170453. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. World Health Organization. Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection Geneva: WHO; 2016. [updated April 2016]. https://www.who.int/hepatitis/publications/hepatitis-c-guidelines-2016/en/ (December 8, 2018). [PubMed] [Google Scholar]
  26. Courtemanche Y, Poulin C, Serhir B, Alary M. Étude de prévalence du VIH et du VHC chez les personnes incarcérées dans les établissements de détention provinciaux au Québec. Québec, QC: Institut national de santé publique du Québec; 2016. French. https://www.inspq.qc.ca/sites/default/files/documents/itss/rapport_vih_vhc_milieu_carceral.pdf (December 12, 2018). [Google Scholar]
  27. Kavasery R, Maru DS, Cornman-Homonoff J, et al. Routine opt-out HIV testing strategies in a female jail setting: a prospective controlled trial. PLoS One 2009;4(11):e7648. 10.1371/journal.pone.0007648. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kavasery R, Maru DS, Sylla LN, et al. A prospective controlled trial of routine opt-out HIV testing in a men’s jail. PLoS One 2009;4(11):e8056. 10.1371/journal.pone.0008056. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Spaulding AC, Adee MG, Lawrence RT, et al. Five questions concerning managing hepatitis C in the justice system: finding practical solutions for hepatitis C virus elimination. Infect Dis Clin North Am. 2018;32(2):323–45. 10.1016/j.idc.2018.02.014. Medline: [DOI] [PubMed] [Google Scholar]
  30. Kronfli N, Linthwaite B, Kouyoumdjian F, et al. Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: a systematic review. Int J Drug Policy. 2018;57:95–103. 10.1016/j.drugpo.2018.04.003. Medline: [DOI] [PubMed] [Google Scholar]
  31. Winter RJ, White B, Kinner SA, et al. A nurse-led intervention improved blood-borne virus testing and vaccination in Victorian prisons. Aust N Z J Public Health. 2016;40(6): 592–4. 10.1111/1753-6405.12578. Medline: [DOI] [PubMed] [Google Scholar]
  32. Beckwith CG, Kurth AE, Bazerman LB, et al. A pilot study of rapid hepatitis C virus testing in the Rhode Island Department of Corrections. J Public Health (Oxf). 2016;38(1):130–7. 10.1093/pubmed/fdv023. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Hickman M, McDonald T, Judd A, et al. Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial. J Viral Hepat. 2008;15(4):250–4. 10.1111/j.1365-2893.2007.00937.x. Medline: [DOI] [PubMed] [Google Scholar]
  34. Craine N, Whitaker R, Perrett S, et al. A stepped wedge cluster randomized control trial of dried blood spot testing to improve the uptake of hepatitis C antibody testing within UK prisons. Eur J Public Health. 2015;25(2):351–7. 10.1093/eurpub/cku096. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. McLeod A, Weir A, Aitken C, et al. Rise in testing and diagnosis associated with Scotland’s Action Plan on Hepatitis C and introduction of dried blood spot testing. J Epidemiol Community Health. 2014;68(12):1182–8. 10.1136/jech-2014-204451. Medline: [DOI] [PubMed] [Google Scholar]
  36. Morey S, Hamoodi A, Jones D, et al. Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine. J Viral Hepat. 2019;26(1):101–8. Epub 2018 Nov 28. 10.1111/jvh.13017. Medline: [DOI] [PubMed] [Google Scholar]
  37. Lamoury FM, Bajis S, Hajarizadeh B, et al. Evaluation of the Xpert HCV Viral Load Finger-Stick Point-of-Care Assay. J Infect Dis. 2018;217(12):1889–96. 10.1093/infdis/jiy114. Medline: [DOI] [PubMed] [Google Scholar]
  38. Canadian AIDS Treatment Information Exchange (CATIE). New point of care hepatitis C antibody test approved in Canada. Toronto: CATIE; 2017. https://www.catie.ca/en/catienews/2017-02-08/new-point-care-hepatitis-c-antibody-test-approved-canada (December 12, 2018). [Google Scholar]
  39. Kuncio DE, Newbern EC, Fernandez-Vina MH, et al. Comparison of risk-based hepatitis C screening and the true seroprevalence in an urban prison system. J Urban Health. 2015;92(2):379–86. 10.1007/s11524-015-9945-4. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Martin NK, Hickman M, Miners A, et al. Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons. BMJ Open. 2013;3(8):e003153. 10.1136/bmjopen-2013-003153. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Martin NK, Vickerman P, Brew IF, et al. Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis. Hepatology. 2016;63(6):1796–808. 10.1002/hep.28497. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Aspinall EJ, Mitchell W, Schofield J, et al. A matched comparison study of hepatitis C treatment outcomes in the prison and community setting, and an analysis of the impact of prison release or transfer during therapy. J Viral Hepat. 2016;23(12):1009–16. 10.1111/jvh.12580. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Pan-Canadian Pharmaceutical Alliance. A statement from the pan-Canadian Pharmac-eutical Alliance. Press release, February 21, 2017. Toronto: CNW Group Ltd.; 2017. https://www.newswire.ca/news-releases/a-statement-from-the-pan-canadian-pharmaceutical-alliance-614373463.html (December 12, 2018). [Google Scholar]
  44. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison – a high risk of death for former inmates. N Engl J Med. 2007;356(2):157–65. 10.1056/NEJMsa064115. Medline:. Erratum in: N Engl J Med. 2007;358(5):536. Corrected at: . [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Bukten A, Stavseth MR, Skurtveit S, Tverdal A, Strang J, Clausen T. High risk of overdose death following release from prison: variations in mortality during a 15-year observation period. Addiction. 2017;112(8):1432–9. 10.1111/add.13803. Medline: [DOI] [PubMed] [Google Scholar]
  46. Binswanger IA, Blatchford PJ, Lindsay RG, Stern MF. Risk factors for all-cause, overdose and early deaths after release from prison in Washington state. Drug Alcohol Depend. 2011;117(1):1–6. 10.1016/j.drugalcdep.2010.11.029. Medline: [DOI] [PubMed] [Google Scholar]
  47. MacDonald R, Akiyama MJ, Kopolow A, et al. Feasibility of treating hepatitis C in a transient jail population. Open Forum Infect Dis. 2017;4(3):ofx142. 10.1093/ofid/ofx142. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Hochstatter KR, Stockman LJ, Holzmacher R, et al. The continuum of hepatitis C care for criminal justice involved adults in the DAA era: a retrospective cohort study demonstrating limited treatment uptake and inconsistent linkage to community-based care. Health Justice. 2017;5(1):10. 10.1186/s40352-017-0055-0. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Schoenbachler BT, Smith BD, Sena AC, et al. Hepatitis C virus testing and linkage to care in North Carolina and South Carolina jails, 2012-2014. Public Health Rep. 2016;131 Suppl 2:98–104. 10.1177/00333549161310S215. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Springer SA, Spaulding AC, Meyer JP, Altice FL. Public health implications for adequate transitional care for HIV-infected prisoners: five essential components. Clin Infect Dis. 2011;53(5):469–79. 10.1093/cid/cir446. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Myers JJ, Kang Dufour MS, Koester KA, et al. The effect of patient navigation on the likelihood of engagement in clinical care for HIV-infected individuals leaving jail. Am J Public Health. 2018;108(3):385–92. 10.2105/AJPH.2017.304250. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Myers JJ, Koester KA, Kang Dufour MS, Jordan AO, Cruzado-Quinone J, Riker A. Patient navigators effectively support HIV-infected individuals returning to the community from jail settings. Int J Prison Health. 2017;13(3–4):213–8. 10.1108/IJPH-08-2016-0037. Medline: [DOI] [PubMed] [Google Scholar]
  53. Koester KA, Morewitz M, Pearson C, et al. Patient navigation facilitates medical and social services engagement among HIV-infected individuals leaving jail and returning to the community. AIDS Patient Care STDS. 2014;28(2):82–90. 10.1089/apc.2013.0279. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Centers for Disease Control and Prevention. Effective interventions: HIV navigation services [Internet]. Atlanta: CDC; c2017. [updated 2018; cited 2018 Dec 18] https://effectiveinterventions.cdc.gov/en/care-medication-adherence/group-2/hiv-navigation-services. [Google Scholar]
  55. Canadian AIDS Treatment Information Exchange (CATIE). Practice guidelines for peer health navigation for people living with HIV. Toronto: CATIE; 2018. http://www.catie.ca/sites/default/files/practice-guidelines-peer-nav-en-02082018.pdf (December 12, 2018). [Google Scholar]
  56. Akiyama M. Implementation and evaluation of a care coordination program for patients with hepatitis C following release from jail. Abstract number: 1010. AASLD Liver Meeting; 2017; San Francisco, CA, USA. [Google Scholar]
  57. Fridriksdottir RH et al. “Marked reduction of hepatitis C prevalence in the prison setting during 2nd year of TraP HepC (Treatment as Prevention for Hepatitis C) program in Iceland.” INHSU 2018, Lisbon, Portugal. [Google Scholar]
  58. Bartlett SR et al. Demonstration of near-elimination of hepatitis C virus among a prison population: The Lotus Glen Correctional Centre hepatitis C treatment project. Clin Infect Dis. 2018;67(3):460–3. 10.1093/cid/ciy210. Medline: [DOI] [PubMed] [Google Scholar]
  59. Cuadrado A, Llerena S, Cobo C, et al. Microenvironment eradication of hepatitis C: a novel treatment paradigm. Am J Gastroenterol. 2018;113(11):1639–48. 10.1038/s41395-018-0157-x. Medline: [DOI] [PubMed] [Google Scholar]
  60. Feld JJ, Jacobson IM, Hézode C, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373(27):2599–607. 10.1056/NEJMoa1512610. Medline: [DOI] [PubMed] [Google Scholar]
  61. Kwo PY, Poordad F, Asatryan A, et al. Glecaprevir and pibrentasvir yield high response rates in patients with HCV genotype 1-6 without cirrhosis. J Hepatol. 2017;67(2):263–71. 10.1016/j.jhep.2017.03.039. Medline: [DOI] [PubMed] [Google Scholar]
  62. Ministère de la Santé et des Services sociaux. La prise en charge et le traitement des personnes infectées par le virus de l’hépatite C – Guide pour les professionnels de la santé du Québec. February 2018. 85p. French. http://publications.msss.gouv.qc.ca/msss/fichiers/2017/17-267-01W.pdf (December 12, 2018).
  63. Kohli A, Kattakuzhy S, Sidharthan S, et al. Four-week direct-acting antiviral regimens in noncirrhotic patients with hepatitis C virus genotype 1 infection: an open-label, nonrandomized trial. Ann Intern Med. 2015;163(12):899–907. 10.7326/M15-0642. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Kohli A, Osinusi A, Sims Z, et al. Virological response after 6 week triple-drug regimens for hepatitis C: a proof-of-concept phase 2A cohort study. Lancet. 2015;385(9973):1107–13. 10.1016/S0140-6736(14)61228-9. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Poordad F, Lawitz E, Gutierrez JA, et al. O006: C-swift: grazoprevir/elbasvir + sofosbuvir in cirrhotic and noncirrhotic, treatment-naive patients with hepatitis C virus genotype 1 infection, for durations of 4, 6 or 8 weeks and genotype 3 infection for durations of 8 or 12 weeks. J Hepatol. 2015;62(Supp 2):S192–3. 10.1016/S0168-8278(15)30013-1. [DOI] [Google Scholar]
  66. Sulkowski MS, Flamm S, Kayali Z, et al. Short-duration treatment for chronic hepatitis C virus with daclatasvir, asunaprevir, beclabuvir and sofosbuvir (FOURward study). Liver Int. 2017;37(6):836–42. 10.1111/liv.13335. Medline: [DOI] [PubMed] [Google Scholar]
  67. Kattakuzhy S, Wilson E, Sidharthan S, et al. Moderate sustained virologic response rates with 6-week combination directly acting anti-hepatitis C virus therapy in patients with advanced liver disease. Clin Infect Dis. 2016;62(4):440–7. 10.1093/cid/civ897. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Gane EJ, Schwabe C, Hyland RH, et al. Efficacy of the combination of sofosbuvir, velpatasvir, and the NS3/4A protease inhibitor GS-9857 in treatment-naïve or previously treated patients with hepatitis C virus genotype 1 or 3 infections. Gastroenterology. 2016;151(3):448–56. 10.1053/j.gastro.2016.05.021. Medline: [DOI] [PubMed] [Google Scholar]
  69. Kattakuzhy S, Gross C, Emmanuel B, et al. Expansion of treatment for hepatitis C virus infection by task shifting to community-based nonspecialist providers: a nonrandomized clinical trial. Ann Intern Med. 2017;167(5): 311–8. 10.7326/M17-0118. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Lloyd AR, Clegg J, Lange J, et al. Safety and effectiveness of a nurse-led outreach program for assessment and treatment of chronic hepatitis C in the custodial setting. Clin Infect Dis. 2013;56(8):1078–84. 10.1093/cid/cis1202. Medline: [DOI] [PubMed] [Google Scholar]
  71. Kirby Institute. Surveillance and treatment of prisoners with hepatitis C (SToP-C) [Internet]. Kensington, NSW: Kirby Institute; c2018. https://kirby.unsw.edu.au/project/stop-c (December 18, 2018). [Google Scholar]
  72. Post JJ, Arain A, Lloyd AR. Enhancing assessment and treatment of hepatitis C in the custodial setting. Clin Infect Dis. 2013;57(Suppl 2):S70–4. 10.1093/cid/cit265. Medline: [DOI] [PubMed] [Google Scholar]
  73. Cooper CL, Hatashita H, Corsi DJ, Parmar P, Corrin R, Garber G. Direct-acting antiviral therapy outcomes in Canadian chronic hepatitis C telemedicine patients. Ann Hepatol. 2017;16(6):874–80. 10.5604/01.3001.0010.5277. Medline: [DOI] [PubMed] [Google Scholar]
  74. Llerena S et al. Poster presentation AASLD 2018: Efficiency of a Telemedicine Program in the Management of Hepatitis C in Inmates. Hepatology, Oct. 36A.28653760 [Google Scholar]
  75. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–207. 10.1056/NEJMoa1009370. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. DeBeck K, Kerr T, Li K, Milloy MJ, Montaner J, Wood E. Incarceration and drug use patterns among a cohort of injection drug users. Addiction. 2009;104(1):69–76. 10.1111/j.1360-0443.2008.02387.x. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Wright NM, Tompkins CN, Farragher TM. Injecting drug use in prison: prevalence and implications for needle exchange policy. Int J Prison Health. 2015;11(1):17–29. 10.1108/IJPH-09-2014-0032. Medline: [DOI] [PubMed] [Google Scholar]
  78. Lafferty L, Rance J, Treloar C. Who goes first? Understanding hepatitis C risk among injecting networks in the prison setting Drug Alcohol Depend. 2018;183: 96–101. 10.1016/j.drugalcdep.2017.10.030. Medline: [DOI] [PubMed] [Google Scholar]
  79. Van der Meulen E. “It goes on everywhere”: injection drug use in Canadian federal prisons. Subst Use Misuse. 2017;52(7):884–91. 10.1080/10826084.2016.1264974. Medline: [DOI] [PubMed] [Google Scholar]
  80. Treloar C, McCredie L, Lloyd AR. The prison economy of needles and syringes: what opportunities exist for blood borne virus risk reduction when prices are so high? PloS One. 2016;11(9):e0162399. 10.1371/journal.pone.0162399. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. World Health Organization (WHO). Declaration on prison health as part of public health. Moscow. Geneva: WHO; 2003. Oct 24. http://www.euro.who.int/__data/assets/pdf_file/0007/98971/E94242.pdf (December 12, 2018. [Google Scholar]
  82. Platt L, Minozzi S, Reed J, et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev. 2017;(9):CD012021. 10.1002/14651858.CD012021.pub2. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Van der Meulen E, Claivaz-Loranger C, Clarke S, Ollner A, Watson TM. On point: recommendations for prison-based needle and syringe programs in Canada. Toronto: Canadian HIV/AIDS Legal Network; 2016. http://www.aidslaw.ca/site/download/13446/ (December 12, 2018). [Google Scholar]
  84. Public Health Agency of Canada. The effectiveness of bleach in the prevention of hepatitis C transmission. Final Report. Ottawa: Public Health Agency of Canada; 2004. http://publications.gc.ca/collections/Collection/H39-4-37-2004E.pdf (January 7, 2019). [Google Scholar]
  85. United Nations Office on Drugs and Crime (UNODC). A handbook for starting and managing needle and syringe programmes in prisons and other closed settings. Advance copy. Vienna: UNODC; 2014. https://www.unodc.org/documents/hiv-aids/publications/Prisons_and_other_closed_settings/ADV_COPY_NSP_PRISON_AUG_2014.pdf (December 12, 2018). [Google Scholar]
  86. Stöver H, Nelles J. Ten years of experience with needle and syringe exchange programmes in European prisons. Int J Drug Policy. 2003;14(5–6):437–44. 10.1016/j.drugpo.2003.08.001. [DOI] [Google Scholar]
  87. Canadian HIV/AIDS Legal Network. Canada can’t wait: the time for prison-based needle and syringe programs is now. Toronto: Canadian HIV/AIDS Legal Network; 2016. http://www.aidslaw.ca/site/canada-cant-wait/?lang=en (December 12, 2018). [Google Scholar]
  88. Correctional Service Canada. Backgrounder: Correctional Service Canada Prison Needle Exchange Program. Ottawa: Government of Canada; 2018. https://www.canada.ca/en/correctional-service/news/2018/05/backgrounder-correctional-service-canada-prison-needle-exchange-program.html#shr-pg0 (December 12, 2018). [Google Scholar]
  89. Stöver H, Hariga F. Prison-based needle and syringe programmes (PNSP) – still highly controversial after all these years. Drugs Educ Prev Policy. 2016;23(2)103–12. 10.3109/09687637.2016.1148117. [DOI] [Google Scholar]
  90. Fullerton CA, Kim M, Thomas CP, et al. Medication-assisted treatment with methadone: assessing the evidence. Psychiatr Serv. 2014;65(2):146–57. 10.1176/appi.ps.201300235. Medline: [DOI] [PubMed] [Google Scholar]
  91. Connery HS. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry. 2015;23(2):63–75. 10.1097/HRP.0000000000000075. Medline: [DOI] [PubMed] [Google Scholar]
  92. Sibbald, B. Methadone maintenance expands inside federal prisons. CMAJ. 2002; 167(10):1154. Medline: [PMC free article] [PubMed] [Google Scholar]
  93. Canadian Centre on Substance Use and Addiction (CCSA). Supporting reintegration in Corrections by addressing problematic substance use: an environmental scan. Ottawa: CCSA; 2017. https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Reintegration-Corrections-Problematic-Substance-Use-Environmental-Scan-2017-en.pdf (March 11, 2019). [Google Scholar]
  94. Correctional Service Canada. Institutional methadone maintenance treatment: impact on release outcome and institutional behaviour. Ottawa: Correctional Service Canada; 2001. https://www.csc-scc.gc.ca/research/r119-eng.shtml (March 11, 2019). [Google Scholar]
  95. Correctional Service Canada. Use of bleach and the methadone maintenance treatment program as harm reduction measures in Canadian penitentiaries. Ottawa: Correctional Service Canada; 2010. http://www.csc-scc.gc.ca/recherche/005008-0210-01-eng.shtml (March 11, 2019). [Google Scholar]
  96. Eibl JK, Morin K, Leinonen E, Marsh DC. The state of opioid agonist therapy in Canada 20 years after federal oversight. Can J Psychiatry. 2017;62(7):444–50. 10.1177/0706743717711167. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]
  97. Jafari S, Copes R, Baharlou S, Etminan M, Buxton JA. Tattooing and risk of transmission of hepatitis C: a systematic review and meta-analysis. Int J Infect Dis. 2010;14(11):e928–40. 10.1016/j.ijid.2010.03.019. Medline: [DOI] [PubMed] [Google Scholar]
  98. Elliott R. Needle exchange in prisons. Deadly disregard: government refusal to implement evidence-based measures to prevent HIV and hepatitis C virus infections in prisons. CMAJ 2007;177(3):262–4. 10.1503/cmaj.070854. Medline: [DOI] [PMC free article] [PubMed] [Google Scholar]

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