HCV testing is warranted at entry to a closed setting, and persons who are anti-HCV-negative should be offered testing periodically or if clinically indicated in order to identify

incident infection. Detainees screening positive for anti-HCV should be offered vaccination against hepatitis A and B, and information regarding risks for disease progression and onward transmission. If identified, acute HCV infection should be treated, as sustained virological response rates are higher than observed in the treatment of chronic infection.[39] Treatment for chronic HCV infection can be provided in closed settings with sustained virological response rates comparable to those in community settings.[40, 41] Providing treatment in closed settings would not only aid detainees but also generate substantial public health benefits, including reducing the pool of infection (thereby reducing Selleck PD0325901 the likelihood of exposure among people engaging in risk behaviors) and reducing the burden of disease associated with chronic HCV infection. There are, however, substantial barriers to widespread implementation of treatment. HCV treatment remains costly and places significant financial burdens on the healthcare budgets of closed settings. Additionally, aspects of life in detention such as high detainee turnover, unpredictable Decitabine access

to healthcare workers, lockdowns, and inadequate nutrition may interfere with demanding treatment regimens that require medication to be taken at regular intervals and careful monitoring of side effects. Meeting these challenges will be crucial as we enter a new era of HCV therapy,[14] MCE公司 as widespread treatment in closed settings has the potential to dramatically reduce the burden of HCV-related disease and should be a public health priority. Only two sources presented data on anti-HCV prevalence among detainees

of extrajudicial detention centers for people who use drugs. In these two studies, prevalence was 80% and 90%, higher than the overall summary estimate of anti-HCV prevalence among detainees with a history of IDU. There are few data enumerating the total population of these detention centers, which exist in China, Lao PDR, Vietnam, Iran, Taiwan, and Thailand, among others.[4, 22] In China alone, perhaps 300,000 people who use drugs are detained in these centers annually; in Vietnam, in excess of 60,000 people are detained at any one time.[4] It is a matter of great concern that there were so few data sources relating to detainees of extrajudicial detention centers for people who use drugs, and that the two available data sources indicated extremely high anti-HCV prevalence. This finding supports the United Nations call for the closure of extrajudicial detention centers for people who use drugs and, pending closure, dramatic improvements in the health services provided to detainees.