An overview of hepatitis C virus in corrections

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.