142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

An overview of hepatitis C virus in corrections

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 12:30 PM - 12:55 PM

Richard Feffer, MS, CCHP , Hepatitis Education Project, Seattle, WA
About 1% of Americans have chronic hepatitis C (HCV). It is likely that the prevalence is actually higher, given that several at-risk groups, including prisoners and the homeless, were not included in the estimate. Left untreated, HCV can lead to cirrhosis and liver cancer, and it is the leading cause of liver transplants in the US.

Acquiring accurate epidemiological data for HCV in corrections is a challenge. Only 12 correctional systems provided routine testing for HCV from 2001-2012. Screening and treatment protocols vary widely by system and it is difficult to get an estimate of how many are providing HCV testing and treatment and to what degree. There is also little or no data on new infection rates during incarceration or for reinfection rates post-incarceration for those who may have been treated behind bars. In addition to a lack of data being generated during incarceration, post-release health outcomes for most HCV patients are not known.

Despite these challenges, we do know that populations at higher risk of acquiring HCV include those below the poverty level, injection drug users, mentally ill, and African Americans, these populations are also more likely to be incarcerated. As a result, correctional institutions face a disproportionate amount of the HCV disease burden. A recently updated estimate of seroprevalence in US prisons came it at 17.4% and chronic infection has been estimated to be between 12 and 35%. Correctional populations represent about 1/3 of total US HCV cases.

Despite the high rates of HCV in corrections, only a small percentage of prisoners with HCV will be tested for HCV and even fewer treated.

There are some public health oriented efforts to increase access to testing and care for incarcerated HCV patients. Some government agencies facilitate interventions in correctional settings and many community based organizations provide education, advocacy, or linkage to care services for HCV. Expanding these services in corrections could have a broad public health impact on the hepatitis C epidemic, by both affecting individual health outcomes and by broadening our understanding of HCV epidemiology.

This presentation covers descriptive epidemiology of HCV in the US broadly and more specifically for prisons and jails. It also identifies potential public health opportunities to improve surveillance and increase access to testing and care for incarcerated populations.

Learning Areas:

Advocacy for health and health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy

Learning Objectives:
Discuss up-to-date epidemiology of the hepatitis C virus (HCV) in the United States Analyze descriptive epidemiology of HCV in US prisons and jails Describe challenges inherent to quality epidemiological surveillance in correctional settings Identify and discuss public health strategies for improving access to appropriate HCV screening and care in corrections.

Keyword(s): Hepatitis C, Prisoners Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a health educator and manage correctional health programs at the Hepatitis Education Project, a 501(c)3 in Seattle. I educate prisoners on hepatitis C (HCV) prevention, self-care and treatment, and advocate for increased access to hepatitis C treatment and care in correctional institutions. I've presented at numerous conferences and meetings on issues related to HCV in prisons and jails.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Gilead Hepatitis C Advisory Committee/Board and Speaker's bureau and teaching engagements
Janssen Hepatitis C Speaker's bureau and teaching engagements

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.