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An opt-out approach to hepatitis C virus testing in English prisons: the literature underpinning the policy

11 November 2021
Volume 30 · Issue 20



The World Health Organization's aim to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030 is dependent on testing people. HCV prevalence is higher in prisons, so to increase test uptake an ‘opt-out’ approach to blood-borne virus testing in English and Welsh prisons was introduced.


This literature review examines the evidence behind the introduction of this public health policy.


Four healthcare databases were searched for publications between January 2000 and February 2020 on the opt-out approach to blood-borne virus testing in prisons.


Sixteen studies published between 2009 and 2019 were included. Analysis of their findings showed that an increase in HCV test uptake in prisons occurs when an opt-out approach is used in combination with additional interventions. Contextual differences between UK and US prisons may affect HCV test uptake.


An opt-out approach to HCV testing in prisons can increase test uptake as part of a complex of interventions.

A global campaign to eliminate hepatitis C virus (HCV) infection as a major public health threat by 2030 was initiated by the World Health Organization in 2016 (World Health Organization, 2016). The UK went one step further, giving itself an accelerated goal of achieving this by 2025 (All-Party Parliamentary Group on Liver Health, 2018). The success of this campaign is critically dependent on an efficient testing process to identify infected individuals who would benefit from viral eradication therapy.

A new class of direct-acting antiviral drugs (DAAs) first became available in 2014. These are oral treatment regimens of 8–12 weeks' duration, which are free from side effects and, importantly, have cure rates in excess of 95% (Pawlotsky et al, 2015). A curative treatment has changed the landscape for testing people at risk of HCV infection because individuals can be linked into an England-wide network of HCV treatment providers.

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