Viral Hepatitis in Incarcerated Adults: A Medical and Public Health Concern

Abstract

Viral hepatitis is a common problem in the incarcerated population. It causes significant morbidity and mortality, and incarcerated inmates receive their health care almost exclusively from corrections-based health systems. The seroprevalence of hepatitis B and C infections is increased in this population, and a number of risk factors for viral hepatitis are particularly common and infer higher risk among inmates, including injection drug use (IDU), high-risk sexual activity, and tattoos. IDU, in particular, has been identified as an important and common risk factor for viral hepatitis in inmates, and variable rates of IDU among inmates have been found to be the most important cause of the marked variability of seroprevalence rates for exposure to hepatitis C virus. A number of risk reduction and management strategies have been identified that can decrease transmission to other inmates. Prison-based hepatitis A and hepatitis B vaccination programs, needle exchange programs, methadone maintenance programs, risk education programs, and hepatitis C virus antiviral programs, for example, have been shown to be safe and effective risk reduction and management strategies. Preliminary studies have shown that these strategies are underutilized in the United States. Reasons for this phenomenon are multifactorial, involving financial as well as ethical and political considerations. Additional funding, research, and formal consideration / discussion of the complex issues involving viral hepatitis in the US incarcerated population are clearly important for the sake of inmates and the community at large. In this article, the published medical literature regarding this important topic is reviewed.

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

“…In the face of limited resources, prioritizing treatment for those with advanced fibrosis has been recommended given the potential for near term morbidity and mortality and the associated costs to the health system. 5,10,14,46 This restrictive treatment scenario would incur costs that amount to 76 % of the current correctional health budget in Rhode Island. This scenario is similar to restrictions placed on treatment under Medicaid in the community and thus to some extent, reflects the community standard of care.…”

“…39,[47][48][49] The benefit of curing hepatitis C in this regard has been well established. 1,5,10 It is important to recognize that these cost savings are to the system as a whole. Departments of corrections will realize those savings only for those likely to develop complications while incarcerated, which includes those with advanced fibrosis and those with very long-term sentences.…”

“…6 Early detection and treatment of infection is necessary prior to development of cirrhosis to avoid these costs. 1,5,10,11 While recommendations for uniform screening based on the age cohort are becoming more widely embraced, targeted screening within key high-risk groups remains important. 1,4 Incarcerated individuals are at high risk for HCV due to higher rates of transmission risk behaviors among those incarcerated, such as injection drug use.…”

“…1,4 Incarcerated individuals are at high risk for HCV due to higher rates of transmission risk behaviors among those incarcerated, such as injection drug use. [10][11][12][13][14][15][16][17][18][19][20] A 2013 meta-analysis estimated the HCV prevalence in general detainees to be 26 % worldwide and 29 % in North America. 16 As HCV testing in corrections is not mandatory in most jurisdictions, the variable prevalence of diagnosed HCV may in part reflect different screening and management practices.…”

Mahkûmlarda Hepatit A, Hepatit B, Hepatit C ve HIV İnfeksiyonu Göstergelerinin Taranması

“…Mahkûmların cezaevlerine gelmeden önceki yaşam tercihleri arasında yer alan özellikle uyuşturucu kullanımı, korunmasız cinsel ilişki ve dövme yaptırılması gibi faktörler bulaşıcı hastalıklar için riski artırıcı nedenlerdir (12).…”