Hepatitis C Testing and Patient Characteristics in Washington State's Prisons Between 2012 and 2016

Abstract

Introduction: There is no widely accepted testing approach for hepatitis C virus infection in correctional settings, and many U.S. prisons do not provide routine testing. The aim of this study was to determine the most effective hepatitis C virus testing strategy in one U.S. state prison and describe the population with reactive testing. Methods: A retrospective analysis was performed using individuals entering the Washington State prison system, which routinely offers hepatitis C virus testing, to compare routine opt-out to current recommendations for risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized using aspartate aminotransferase to platelet ratio index and Fibrosis-4. Analyses were conducted in 2017. Results: Between 2012 and 2016, a total of 24,567 (83%) individuals were tested for the hepatitis C virus antibody and 4,921 (20%) were reactive (test was positive). There were 2,403 (49%) that had hepatitis C virus RNA testing with 1,727 (72%) showing chronic infection. Reactive antibody was more prevalent in individuals born between 1945 and 1965 compared with other years (44% vs 17%); however, most cases (72%) were outside of this cohort. Up to 35% of positive reactive tests would be missed with testing targeted by birth cohort and risk behavior. Of chronically infected individuals, 23% had at least moderate liver fibrosis. Conclusions: Targeted testing in the Washington State prison system missed a substantial proportion of hepatitis C virus cases; of those with reactive testing, a sizeable proportion of people had at least moderate liver disease placing them at risk for complications. Routine testing at entry should be considered by U.S. state prisons.

Prevalence of Viremic hepatitis C, hepatitis B, and HIV infection, and vaccination status among prisoners in Stockholm County

“…The prevalence of viremic HCV infection in our study is within the range of 1.5–20% that has been reported in a limited number of studies around the world, i.e. from Italy, Egypt, Brazil, Hungary, Spain, France, UK, Australia, USA, and Denmark [12–22].…”

“…Consequently, a high prevalence of HCV antibodies (anti-HCV) among prisoners globally has been reported, varying from 3 to 38% depending on region [10, 11]. The prevalence of viremic HCV infection has been less studied, with prevalence rates of 1.5–20% in a limited number of countries [12–22].…”

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

“…Therefore, the well-documented prevalence of HCV infection in a variety of correctional jurisdictions supports the application of these guidelines to prisons and jails. Universal hepatitis C testing in correctional facilities can be expected to yield higher infection identification rates compared with the risk-based testing practices that many jurisdictions employ (98,99) and to support broader hepatitis C elimination efforts (34,100,101).…”

Advancing Hepatitis C Elimination through Opt-Out Universal Screening and Treatment in Carceral Settings, United States

“…During 2004–2012, the Pennsylvania Department of Corrections (DOC) successfully began a universal opt-out screening program resulting in 93% of incarcerated persons screened for HCV at intake ( 19 ). Similarly, the Washington DOC successfully screened 83% of its incarcerated population during 2012–2016 ( 25 ). The Pennsylvania and Washington screening programs identified 18%–20% HCV seropositivity rates ( Table 1 ) ( 19 , 25 ).…”