Hepatitis C screening in jails could help combat epidemic

Woodruff Health Sciences Center | April 10, 2012

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Persons released from the criminal justice system may account for a substantial proportion of the 2.7 million to 3.9 million persons infected with HCV in the United States, say authors of a study recently published in JAMA.

A new Emory University study says screening for hepatitis C virus (HCV) infection in jail detainees could help combat the HCV epidemic in the United States.

According to the article, if 70 percent of approximately one million persons with HCV who pass through correctional facilities are offered HCV testing, and if 70 percent accept such an offer, HCV screening in detainees may lead to the identification of as many as a half million new cases of hepatitis C in the first year of the program. The findings were published in the March 28 issue of JAMA.

"Implementing opt-out HCV screening for persons incarcerated in jail should be seriously considered as a way to increase the number of persons nationwide who know their diagnosis," says lead author Anne Spaulding, MD, MPH, assistant professor of epidemiology at Emory’s Rollins School of Public Health.

"Jails are an ideal setting for routine infectious disease screening and with new treatments that are curing a substantially greater number of people infected with HCV, there is real potential to reduce the number of cases across the US."

According to the Centers for Disease Control and Prevention, HCV infection is the most common chronic blood borne infection in the United States and the leading indication for liver transplants. It estimates that at the turn of this century 16 to 41 percent of US inmates had serological evidence of prior HCV exposure and 12 to 35 percent had chronic infection.

The authors say this high prevalence of HCV, coupled with the fact that more than seven million individuals passed through jails and prisons each year in the late 1990s, suggested that persons released from the criminal justice system may account for a substantial proportion of the 2.7 million to 3.9 million persons infected with HCV in the United States.

"Currently, many people first learn they are infected when they go to prison to serve felony sentences.  If they had found out about their infection years earlier during a brief jail stay, which most of them have experienced, they could have sought care in the community."

Seeking treatment for patients while they are in the community could help ease the economic impact of HCV on prison systems.

"HCV prevalence is relatively low in community health centers and the costs associated with treating it will not overwhelm the community system," explains Spaulding.

"To put the responsibility of treatment on a state prison system - which might need to treat 500 prisoner-patients because of the current high prevalence of HCV in that setting - could cost $25 million, a figure that easily overwhelms a prison system’s operating budget."

Despite the benefits, Spaulding says there are challenges to public health agencies inviting jails to partner in the widespread implementation of HCV screening. For one, provision of medical screening and treatment is not the primary mission of short-term and long-term correctional facilities.

Jails are also challenged with high volumes of people and entrants may have insufficient time for the counseling and confirmatory testing that are optimal in HCV screening programs.

The authors say these challenges can be overcome, in part, by focusing efforts on detainees with a high pretest probability of having HCV, especially persons born between 1945 and 1965, the range of years that includes an estimated two-thirds of those individuals currently infected with HCV in the United States.