Hepatitis C through the lens of Correctional Health Services

Deaths attributable to hepatitis C virus (HCV) have surpassed deaths from HIV and are expected to continue rising in the coming decades (Rein 2011). The disproportionate impact on criminal justice involved people can be seen through an examination of health care provision in the New York City jail system – through quantifiable measures such as prevalence and cost, as well as through clinical review of morbidity and mortality.

Prevalence of HCV antibody positivity in the NYC jails was estimated to be 12.5% in 2006 (internal serosurvey data), however case identification varied based on provider practice and facility. In 2013, a policy promoting birth-cohort screening in addition to risk factor screening was implemented. Average monthly testing increased from approximately 400 tests per month in May 2013 to over 1000 tests per month in October 2013. In July 2014, a pilot program to evaluate universal rapid testing was conducted in the largest facility in the system, one which also houses a population with a higher prevalence of substance use and mental health disorders. During the three month pilot 1305 patients received rapid HCV testing and overall prevalence in this high risk population was estimated to be 23%. Based on an expected treatment cost of $70,000 per course of treatment, the cost of averaging just ten patients on treatment daily is three million dollars per year. The burden of HCV infection in the jails is also reflected in its clinical impact. Review of all medical deaths from 2012 through 2014 found that HCV was comorbid in 68% (19/28) and was the primary cause of death in 25% (7/28). Though a small sample, this appears to be a higher rate of HCV related death when compared with data from 2001-2009 demonstrating that liver disease accounted for 4.5% of deaths in the NYC jail system (Brittain 2013).

The high prevalence of HCV in jails has major implications for screening practices, costs and patient outcomes. While there is opportunity to scale up treatment, significantly increased funding or decreased treatment prices will be necessary to mitigate the burden of the disease for our patients and the system in coming years.