Hepatitis C and the Criminal Justice System: How Decision Support Tools Can Help

Despite significant progress towards eradicating hepatitis C virus (HCV) achieved through the emergence of novel direct-acting antiviral drugs, significant hurdles stand in the way of completely eradicating the infection. In the United States alone, more than 4 million individuals have HCV.
 
HCV infections have the greatest concentration within the US criminal justice system. Approximately 17% of inmates are HCV positive, a rate that is nearly 10 times higher than the general public. Due to budget constraints, many prisons cannot afford to treat all of these patients, according to a press release from the Georgia Tech College of Engineering.
 
Novel research from the college has analyzed the efficacy of implementing screening and treatment programs in prisons to reduce the burden of HCV. Specifically, the use of decision support tools may help prison health care professionals outline the best treatment plans for inmates, according to the release.
 
“Because of cost constraints, prisons cannot afford to treat every inmate with hepatitis C, so prioritization decisions have to be made,” said researcher Turgay Ayer, PhD. “My research is dedicated to enabling decision-makers in prison systems to make the best choice possible to treat the most people with the given budget they have.”
 
The novel decision support tool aids providers in deciding who to treat first and accounts for factors such as disease progression, injection drug use (IDU), and prison sentence, according to Georgia Tech.
 
Unlike other diseases, more advanced HCV may not be the only factor to consider when determining which patients to treat.
 
“Ninety-five percent of inmates are released in less than 5 years,” Dr Ayer said. “While mostly it makes sense to prioritize sickest patients with longest length of sentences, in certain cases, prioritizing IDU patients with shorter length of sentences may help more effectively reduce future infections and save on costly liver transplants or cancer treatments down the road. It’s known as treatment as prevention.”
 
The novel decision tool can also help standardize treatments for inmates with HCV. The tool accounts for disease progression, treatment effect, and treatment capacity to determine which patient should be prioritized, according to the release.
 
Dr Ayer noted that the budget of the prison may also dictate who receives priority treatment, and because finances vary greatly among institutions, the tool may help standardize practices and improve patient outcomes, Georgia Tech reported.
 
Currently, 2 prisons are conducting a real-world evaluation of the decision support tool.
 
“The United States is in the midst of a hepatitis C virus epidemic, and our data-driven model and Decision Support Tool can help to manage the disease burden in a cost-effective way,” Dr Ayer said. “If WHO’s aim is to eliminate an infectious disease that is 10 times more prevalent in prisons, you can’t ignore that population. Making smart decisions in the prison systems by using capacity in an optimal way when resources are limited saves more lives and prevents future infections.”


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