Filipa Alves da Costa, Researcher at iMed.ULisboa and Professor at the Faculty of Pharmacy of the University of Lisbon (FFUL), is part of the international team that published, this week, an article that for the first time establishes global guidelines for the provision of health services aimed at the prevention and treatment of viral hepatitis in prisons. The work, published in the scientific journal The Lancet Infectious Diseases, brings together the best available evidence and proposes concrete pathways to accelerate the elimination of hepatitis B (HBV) and C (HCV) in this setting.
Prisons are now recognised as critical locations for the transmission of viral hepatitis, mainly due to factors such as the sharing and use of non-sterile needles for tattooing and injecting drug use, unprotected consensual or coercive sexual practices, and limited access to healthcare. The globally estimated prevalences — 4.5% for HBV and 11% for HCV, substantially higher than in the general population — place these environments at the centre of major public health challenges.
Despite this, most countries still do not include prisons in their national hepatitis elimination plans, undermining progress towards the World Health Organization targets for 2030.
The new article results from a comprehensive process that included a systematic review of 703 studies and the development of recommendations assessed according to the GRADE methodology by an international panel of experts, researchers, healthcare professionals and individuals with lived experience in prison settings. The document presents 30 key recommendations to transform the global response to hepatitis B, C and A in prisons, establishing for the first time a uniform and evidence-based normative framework.
Main Recommendations of the Global Guidelines
The guidelines outline a set of essential measures to ensure prevention, diagnosis, treatment and continuity of care equivalent to that available in the community:
– Universal testing at prison entry: Systematic HBV and HCV testing upon admission, unless explicitly declined, ensuring high coverage and equitable access to diagnosis.
– Universal access to direct-acting antivirals (DAAs) and rapid test-and-treat pathways: Simplified, rapid and effective treatment models, including point-of-care approaches that substantially increase treatment initiation and completion.
– Continuity of care before, during and after incarceration: Preventing treatment interruptions during transfers or release, and ensuring direct linkage to community healthcare services after release.
– Harm reduction as a central component: Opioid substitution therapy (OST), needle and syringe programmes, and safe tattooing programmes.
– Education and peer involvement: Educational programmes for incarcerated people, healthcare teams and prison staff, valuing the role of peers with relevant lived experience.
– Regular monitoring and evaluation: Systematic data collection on prevalence, incidence, testing and treatment, aligned with surveillance practices in the community.
– Prioritisation of minorities and population groups requiring specific considerations: Tailored approaches for vulnerable groups who face increased risks and significant barriers to accessing care (e.g. women, transgender people, men who have sex with men, people who use drugs, among others).
This publication reinforces the urgent need to integrate prisons into national viral hepatitis elimination plans and to invest in policies grounded in evidence, equity and human rights.
