Hepatitis C Testing and Linkage to Care Among Adults on Probation in a Large US City

Abstract

Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a lab-based HCV RNA assay if anti-HCV positive. All individuals received counseling rooted in harm-reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless lost to follow-up. Study participation involved an optional survey and optional point-of-care HIV test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34/52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. 193 individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage-to-care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage-to-care could improve health in this population. Co-localization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.

A retrospective, descriptive study of hepatitis C testing, prevalence, and care continuum among adults on probation

“…Our results align with other studies which have shown a higher prevalence among adults on probation compared to the general population (Hawks et al, 2020;Zaller et al, 2016). We recently published results of a prospective HCV testing and linkage to care program located on-site at the same probation department of this retrospective analysis (Kamis et al, 2022). In that study, 13% (56/417) of individuals tested anti-HCV positive, and of the 34 individuals who were found to have detectable HCV RNA, 14 (41%) linked to care and 1 (3%) achieved cure.…”

“…Some studies have assessed HCV prevalence among this population, including a study that found 9% (12/130) HCV antibody positivity among a group of individuals on probation or parole in Rhode Island (Zaller et al, 2016) and a national survey that found a nearly five-fold higher adjusted odds ratio of having hepatitis C or hepatitis B among probationers compared to the general population (Hawks et al, 2020). Our group conducted a study of HCV testing located on-site at a probation department where we found a 13% HCV antibody positivity among the 417 individuals tested (Kamis et al, 2022).…”

“…Individuals tested for HCV on-site at the probation office through community-based outreach testing via a Denver Health/Denver Adult Probation partnership that launched September 5, 2018 were excluded. The results of this study are published elsewhere (Kamis et al, 2022).…”

People in community corrections are a population with unmet need for viral hepatitis care

“…High attrition was also observed in Denver, Colorado; among 52 participants testing hepatitis C antibody positive using onsite point of care tests with reflex to offsite RNA testing using the same blood sample, 34 (65%) had detectable hepatitis C RNA, of which 14 (27%) were linked to a treatment provider, and only four (8%) completed treatment. 26 …”

The Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes (DETECT) for Hepatitis C (Hep C) Linkage-to-Care Trial: rationale and design of an emergency department-based randomized clinical trial of linkage-to-care strategies for hepatitis C

“…However, unlike HCV, many HIV testing programs have successfully implemented active linkage programs, yielding successful linkage rates of well over 80% within 3 months of HIV diagnosis [13]. Linkage navigators have been utilized in community-based HCV testing programs, but while the role of navigation has been described in these settings, the added benefit of a linkage navigator above and beyond standard clinician referral has not been evaluated in a prospective, comparative manner [14][15][16]. Additionally, the effectiveness of navigators for people who inject drugs (PWID), a traditionally under-treated population, has not been assessed.…”