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Prisoners to be screened for hepatitis C ahead of WHO elimination deadline of 2030

Fewer than 5,000 people in Ireland estimated to have disease but many are hard-to-reach drug users

Prisoners across the country are to be tested for hepatitis C as part of efforts to try to eliminate the disease by the end of the decade.

Screening of all pregnant women for hepatitis C has also been proposed as an effective way of tracking down undiagnosed cases of the blood-borne disease and making it a rare condition by 2026.

New-generation antiviral drugs make the treatment of hepatitis C simple and highly effective. The virus can be eliminated in more than 95 per cent of cases by taking a course of tablets for eight to 12 weeks. Side-effects are rare.

There are now fewer than 5,000 people who remain to be treated for the disease in Ireland, according to the Health Service Executive, but because many are intravenous drug users, finding and treating them is challenging. Almost 300 people have had to be retreated due to reinfection or failing to complete an initial course of treatment.

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The World Health Organisation has set 2030 as the target date for eliminating hepatitis C, which means a prevalence of 0.05 per cent or less in the population.

“With a current prevalence of 0.09 per cent, the programme is satisfied that we will reach this target well before 2030, barring unforeseen events,” the HSE says.

The extension of hepatitis C treatment away from traditional-based healthcare and within addiction treatment centres has begun, with initial outcomes “extremely positive”, it adds. Last year, Ireland became the first country to establish a publicly funded home-testing service for hepatitis C.

The treatment programme has agreed to fund a nurse to co-ordinate the testing and treatment of hepatitis C in the prison service outside Dublin. Up to now, this service has been available in Dublin prisons only.

However, Prof Jack Lambert, infectious diseases consultant at the Mater hospital in Dublin, says meeting the WHO target will be “a huge challenge”.

“The easy targets for treatment have all been dealt with by now. Those left need a lot of support. It’s not more nurses we need; it’s about peer support for drug users to help them navigate the system and start treatment.”

The Mater, he points out, is the only hospital employing a peer-support worker to reach out to such at-risk groups.

Bernard West, a former addict and prisoner who has been successfully treated for the disease, works as a hepatitis “buddy/friend” supporting people undergoing treatment. “My clientele includes homeless people, chaotic drug users, people coming from prison. Even to get them to a first appointment can be difficult,” he says.

Most people with hepatitis C have no discernible symptoms, just non-specific signs such as general fatigue. People can live for decades with the virus before health complications arise.

About 70-80 per cent develop chronic liver disease, while 20-30 per cent develop cirrhosis of the liver, which tends to appear after two or three decades.

A 2021 study showed the prevalence of hepatitis C infection in pregnant women in Dublin had declined by 65 per cent over two decades. It recommended universal screening during pregnancy as screening based on risk factors misses a significant proportion of infections.

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Paul Cullen

Paul Cullen

Paul Cullen is a former heath editor of The Irish Times.