Dr Cristina Sotomayor-Castillo1,2,3, Mr Gary Gahan1, Ms Jacqueline Clegg1, Ms Claire Allen1, Mr Allan O'Brien1
1Justice Health NSW, Population and Preventative Health Directorate, Population Health, Malabar, Australia, 2Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia, 3Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
Biography:
Cristina leads infectious diseases surveillance at Justice Health NSW, focusing on custody and post-release care. She supports outbreak response and monitors progress toward NSW Hepatitis C elimination by 2028 in custodial settings. She collaborates across other health sectors and lectures on IPC and infectious diseases at The University of Sydney.
Abstract:
Introduction
Hepatitis C (HCV) remains a significant concern for people in custody. Justice Health NSW (JHNSW) delivers healthcare across 37 correctional facilities statewide, where Aboriginal Peoples are significantly overrepresented. Since 2016, JHNSW has implemented prison-based direct-acting antiviral (DAA) HCV treatment programs to reduce transmission during incarceration and post-release. Despite these efforts, surveillance data highlights a disproportionate burden and high reinfection rates among Aboriginal Peoples. In order to achieve HCV elimination in NSW by 2028, culturally responsive and targeted strategies are urgently needed.
Methods
A retrospective descriptive study examined HCV treatment trends among Aboriginal Peoples in custody across NSW from FY2015/16 to FY2024/25-Q3, focusing on treatment uptake and retreatment patterns.
Results
Since 2016, 8,424 HCV treatments have been dispensed, with 45.4% (n=3,821) provided to Aboriginal Peoples. Among these, 33.3% (n=1,273) required two or more treatments, compared to 20.8% (n=893) among non-Aboriginal patients. While most first-time treatments were for non-Aboriginal individuals, subsequent treatments showed a growing majority among Aboriginal Peoples: 54.1% (n=871) of second treatments, 64.2% (n=364) of third, 72.8% (n=151) of fourth, and 77.8% (n=63) of fifth treatments. All individuals receiving six or seven treatments identified as Aboriginal Peoples.
Conclusions
JHNSW is the only jurisdiction with established active HCV retreatment surveillance, alongside early detection through onsite testing, harm reduction programs, and workforce development strategies across all correctional centres. However, in order to address the disproportionate reinfection burden among Aboriginal Peoples in custody, culturally safe, community-informed models are essential to close gaps in harm reduction, testing, and continuity of care.