New European toolkit for the elimination of viral hepatitis in prisons: Luxembourg cited as best example of models of care

• Infection and Immunotherapy Reseach Group
• Department of Infection and Immunity

The European Union Drugs Agency (EUDA) and the European Centre for Disease Prevention and Control (ECDC) have jointly produced a European toolkit for the elimination of viral hepatitis in prisons. The new toolkit is designed to support the implementation and scale-up of hepatitis B and C interventions in prisons across Europe. It also reinforces the principle of ‘equivalence of care’, ensuring that people in prison receive healthcare comparable to that available in the community.

People in prison experience higher levels of viral hepatitis than the general population, making them a key group for targeted prevention and treatment. In Europe, individuals entering prison are also more likely to have a history of injecting drugs, a major risk factor for hepatitis B and C virus transmission. The sharing of injection equipment and other risk factors such as unsafe tattooing or body piercing practices, sharing of razors, and unprotected sex, make prisons a priority setting for targeted viral hepatitis prevention and treatment interventions.

Dr Carole Devaux, head of the Infection & Immunotherapy Research Group at the LIH, helped guide the development of the toolkit as part of the Advisory group. She described the comprehensive and tailored viral hepatitis prevention and control programme established in collaboration with Dr Philippe Poos from the prison health services and Dr Pit Braquet from the National Service of Infectious Diseases.

The toolkit consists of four key sections: background, strategy development, strategy implementation, monitoring, and evaluation. It includes links to relevant public health measures and practical tools to understand the context, define, and implement an elimination strategy inside prisons. The toolkit also provides examples from prisons in Germany, Spain, France, Italy and Luxembourg, illustrating different models of care, of which Luxembourg was cited as one of the best cases.

Tackling viral hepatitis in prison doesn’t just help prisoners, it also delivers health benefits to the wider community by driving down the overall disease burden and preventing future transmission. We refer to this as a ‘community dividend,

explained Dr Carole Devaux.

In Luxembourg, universal access to a viral hepatitis elimination programme is given to all individuals entering prison, including those with substance use disorders. Furthermore, needle exchange programs, safe tattooing services, annual follow-ups, free condom provisions, as well as vaccinations for hepatitis A and B reduce the spread of infectious diseases among the incarcerated population.

Between 2012 and 2022, over 6500 individuals were screened by the programme and while the prevalence of HAV (26%), HBsAg (3%), HIV (2%), Quantiferon Tb (27%) and active syphilis (<1%) has remained stable, HCV serology and HCV-RNA have significantly decreased from 19% to 10% (p<0.001), and from 11% to 3% (p<0.001), respectively, at entrance screening. Reinforcement of these services for everyone after prison release is the next step towards eliminating HCV in Luxembourg.