Hepatitis C Virus Infection in the Dallas County Jail: Implications for Screening, Prevention, and Linkage to Care

Abstract

Objectives: Screening for hepatitis C virus (HCV) infection in jail provides an opportunity to educate and offer care to a high-risk population. We aimed to (1) estimate the prevalence of HCV infection in jail; (2) describe the demographic characteristics, risk factors, and pre-incarceration health insurance status associated with HCV infection; and (3) examine the implementation of HCV screening in jail. Methods: We conducted a retrospective analysis of an opt-out HCV screening program with HCV RNA confirmation and patient education at the Dallas County Jail from April 1 through November 2, 2017. We extracted data on test results, demographic characteristics, and release destination from electronic medical records. A nurse navigator recorded data on patient self-reported risk factors and pre-incarceration health insurance status. Results: Of 4089 incarcerated persons screened, 708 (17.3%) had a positive HCV antibody result. Of these, 641 (90.5%) had an HCV RNA test ordered; 576 (89.9%) had RNA tests completed, of whom 413 (71.7%) had a positive HCV RNA result. Of these 413, 352 (85.2%) received patient education. Half of HCV RNA-positive incarcerated persons (n = 207, 50.1%) were born outside the birth cohort (1945-1965). Among those with HCV infection, commonly reported risk factors were injection drug use (168 of 352; 47.8%) and tattoos (82 of 352; 23.4%). Most incarcerated persons with HCV infection (284 of 350; 81.1%) did not have health insurance. HCV antibody prevalence was higher among incarcerated persons released to prison (232 of 961; 24.1%) than to outside agencies (38 of 403; 9.4%) or the community (178 of 1026; 17.4%). Conclusions: Screening for HCV with RNA confirmation in jail provides an opportunity for disease education, transmission prevention, and navigation to HCV treatment. Future efforts should examine post-incarceration linkage to care.

Innovations in Hepatitis C Screening and Treatment

“…61 Implementation of reflex HCV RNA testing with antibody screening further streamlined diagnosis. 62 A comprehensive approach can couple screening with linkage to care. Drawing on a nationally recognized link to care program called transitional care coordination (TCC), 63 which provides medical case management, counseling, and comprehensive discharge planning for incarcerated people living…”

“…( 59 ) Implementation of reflex HCV‐RNA testing with antibody screening further streamlined diagnosis. ( 60 )…”

“…(59) Implementation of reflex HCV-RNA testing with antibody screening further streamlined diagnosis. (60) A comprehensive approach can couple screening with linkage to care. Drawing on a nationally recognized linkage-to-care program called transitional care coordination (TCC), (61) which provides medical case management, counseling, and comprehensive discharge planning for incarcerated people living with HIV/AIDS, Akiyama et al developed a similar program for inmates with reported HCV mono-infection at three New York City (NYC) jails and one hospital correctional health ward.…”

Hepatitis C Epidemiology in a Large Urban Jail: A Changing Demographic

“…Nearly 1 in 3 people living with HCV infection passantibody–positive, the average age through the criminal justice system each year; people who are incarcerated are 9 times more likely than the general population to be living with HCV infection. 1,9,10 Although several studies demonstrated successful HCV testing and a high HCV antibody prevalence in the criminal justice system, 1,11-20 including studies from our own institution, 21,22 limited data exist about the incidence of HCV in criminal justice settings or which demographic subgroups are at increased risk of HCV infection.…”

“I’m not gonna be able to do anything about it, then what’s the point?”: A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail

“…No guidelines exist for HCV testing in jails, where most incarcerations last less than 6 months. Increasing HCV testing in jails [ 12 ] and linking to HCV treatment on release have been shown to be feasible and effective [ 13 – 15 ], but only 4% of jails offer routine opt-in HCV testing [ 16 ].…”