Birth Cohort Screening Will Only Identify a Minority of Individuals with Hepatitis C in Correctional Settings

Hepatitis C (HCV) is primarily transmitted through injection drug use and disproportionately affects people in contact with the criminal justice system. In addition to testing high-risk individuals, the CDC has recommended one-time testing of everyone born between 1945 and 1965; this was based on data from National Health and Nutrition Examination Survey (NHANES), which found that 82% of people with HCV in the US were in this birth cohort. However, NHANES did not include incarcerated persons. Researchers used data from the Pennsylvania Department of Corrections, which has offered all entrants opt-out testing for HCV since 2003, to examine the prevalence of anti-HCV antibodies among inmates.

• Overall, anti-HCV prevalence was 18% and the highest prevalence was among those born between 1950 and 1954 (45%). Prevalence was higher among women (31%) than men (17%).
• Testing limited to the 1945–1965 birth cohort would identify 44% of male and 29% of female inmates with HCV.

Comments:

This study shows that HCV is highly prevalent in correctional settings and suggests that all entrants should be offered testing. With the availability of more effective treatments, a “test and treat” approach in correctional settings would probably have a significant impact on the prevalence and burden of this disease, but the current cost of HCV medications presents a major barrier.

Darius A. Rastegar, MD

Reference:

Larney S, Mahowald MK, Schaff N, et al. Epidemiology of Hepatitis C Virus in Pennsylvania state prisons, 2004–2012: Limitations of 1945–1965 birth cohort screenings in correctional settings. Am J Pub Health. 2014;104(6):e69–74.