Abstract
BackgroundIncarcerated populations are disproportionately burdened by hepatitis C virus (HCV) infection. The introduction of highly-effective, direct-acting antiviral (DAA) treatment has potential to substantially reduce the burden of liver disease in this population, but accurate information about access to and utilization of this treatment is currently limited. The goals of this study were to characterize receipt of HCV care and treatment services for a cohort of HCV-infected adults identified in a state prison system, and to describe the complex health needs of this population.MethodsTo estimate the proportion of patients who were treated for HCV while incarcerated, and the proportion linked to HCV care after release from prison, we used a deterministic matching algorithm to link administrative prison data, health care records, and a state public health surveillance database, which captures all positive HCV-related diagnostic test results through automatic laboratory reporting. Individuals not evaluated or treated for HCV while in prison were considered likely to have been linked to care in the community if the HCV surveillance system contained a record of a quantitative HCV RNA or genotype test within 6 months of their release date. Demographic and comorbidity data were manually extracted from the electronic health records for all patients referred for consideration of HCV treatment.ResultsBetween 2011 and 2015, 3126 individuals were known to be living with chronic HCV infection while incarcerated in the state prison system. Of these, 570 (18%) individuals were evaluated for HCV treatment while incarcerated and 328 (10%) initiated treatment with DAAs. Of the 2556 individuals not evaluated for treatment, 1605 (63%) were released from prison during the 5 year study period. Of these, 138 (9%) individuals engaged in HCV care in the community within 6 months. Data describing medical and psychiatric co-morbidities were available for the prison-based treatment cohort, which showed a high prevalence of major depression (39%), anxiety disorder (24%), alcohol misuse (52%), cocaine use (52%) and prior injection drug use (62%).ConclusionDespite HCV treatment advances, linkage to care and treatment rates for criminal-justice involved adults remains low, particularly for those who must seek care in the community after release from prison. Treating criminal-justice involved individuals for HCV during incarceration provides an opportunity to improve linkage to care and treatment rates among this vulnerable population.
Highlights
Incarcerated populations are disproportionately burdened by hepatitis C virus (HCV) infection
Investigation of the 58 who did not achieve sustained virologic response (SVR) led to the discovery that 41 (71%) of these individual’s treatment regiments included pegylated interferon and ribavirin during early phases of the study period, which is known to have a lower cure rate and increased side effects compared to direct-acting antiviral (DAA) based treatments (Manns et al 2001)
We found that 570 (18%) of the 3126 HCV-infected inmates engaged in HCV care during incarceration, 328 (10%) received treatment, and of the 244 whose treatment outcomes were documented in the electronic medical records (EMR) system 12–24 weeks after treatment initiation, 186 (76%) achieved SVR
Summary
Incarcerated populations are disproportionately burdened by hepatitis C virus (HCV) infection. The goals of this study were to characterize receipt of HCV care and treatment services for a cohort of HCV-infected adults identified in a state prison system, and to describe the complex health needs of this population. Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Chronic HCV can result in serious health complications including liver damage, liver failure, liver cancer, and death. 19,000 people die annually as a result of a HCV-related liver disease (Centers for Disease Control and Prevention 2016a). Due to a high lifetime prevalence of injection drug use, incarcerated populations are disproportionately burdened by chronic HCV (Spaulding et al 2006). An estimated one-third of HCV-infected individuals in the U.S pass through the correctional system, placing this system in a key position to control the HCV epidemic (Varan et al 2014)
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