Routine Versus Targeted Hepatitis C Testing in US State Prisons

Routine hepatitis C virus (HCV) testing in correctional facilities may be a more effective strategy than a targeted approach to eliminate HCV transmission in prison populations, according to a new study led by Boston Medical Center.
With no widely accepted testing approach for HCV in prison settings, many correctional facilities approach screening differently. The CDC currently recommends targeted or risk-based testing for individuals born between 1945 and 1965, as well as those with a history of injection drug use. However, a new study published in the American Journal of Preventive Medicine suggests that many cases of HCV go undiagnosed with this approach and that routine testing may be a more effective option in prison populations.
For the study, the researchers conducted a retrospective analysis using individuals entering the Washington State prison system, which offers routine HCV testing, to compare routine opt-out testing with the current recommendations. Based on the data, 24,567 individuals were tested for HCV between 2012 and 2016, 20% of whom tested positive and 1727 showed chronic infection. Of those with chronic infection, 23% had at least moderate liver fibrosis, according to the study.
The study showed that 72% of HCV cases were outside of the cohort of individuals born between 1945 and 1965. The researchers estimated that up to 35% of infections would have been missed with testing targeted by birth cohort and risk behavior.
Beyond screening and diagnosis, there are additional challenges surrounding access to treatments within the prison system. A recent Kaiser Health News report found that state prisons in the United States are failing to treat at least 144,000 inmates. Their report, based on a survey and subsequent interviews with state corrections departments, indicated that approximately 97% of inmates with HCV are not being treated, with high drug costs cited as the reason.
Despite this, increased testing and diagnoses can still help stem the spread of HCV. Even without treatment, those who receive diagnosis may make lifestyle changes that can reduce transmission, the study noted.
Overall, the researchers found that targeted testing missed a substantial proportion of HCV cases, with many of the individuals who tested positive having at least moderate liver disease. Although it is unclear how these findings will translate to other US prison populations, the study authors concluded that routine testing at entry may be considered by US state prisons and further research should be done to determine the effectiveness of this approach.  
Assoumou SA, Wang J, Tasillo A, et al. Hepatitis c testing and patient characteristics in Washington state’s prisons between 2012 and 2016. American Journal of Preventive Medicine. 2018. Doi:

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