Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Estimates of Hepatitis C Seroprevalence and Viremia in State Prison Populations in the United States.” Spaulding AC, Kennedy SS, Osei J, Sidibeh E, Batina IV, et al. Journal of Infectious Diseases 2023; 228 (S3): S160-S167.
What question(s) does this study address?
In the United States and elsewhere around the world, persons who are incarcerated in jails and prisons have a higher prevalence of hepatitis C virus infection compared to the general population. This disproportionate burden of Hepatitis C infection is related to the fact that lack of access to sterile injection equipment can facilitate the rapid spread of this bloodborne virus and many persons with substance use disorders, including injection drug use, are incarcerated.
Although comprehensive nationwide data are scarce, one can safely assert that many incarcerated persons in the U.S. with chronic Hepatitis C infection have not been diagnosed and an even smaller number have been successfully treated. As such, it’s no surprise that the current administration’s plan for a national Hepatitis C elimination program identifies correctional facilities as “high impact settings” for the implementation of Hepatitis C micro-elimination efforts.
By itself, information on Hepatitis C seroprevalence (i.e., identifying those who are Hepatitis C antibody positive) is not adequate to guide elimination efforts. To determine the current burden of active Hepatitis C infection, one must also conduct Hepatitis C RNA testing to determine the presence of viremia (i.e., the existence of Hepatitis C virus in the blood). Surveying state prison systems between 2019 and 2023 and using publicly available data to corroborate survey responses and fill in data gaps, these researchers sought to estimate levels of Hepatitis C viremia in state prison populations in the United States.
What are the major findings of this report/article?
- Hepatitis C seroprevalence data were available from 47 state prison systems; the average Hepatitis C antibody prevalence was estimated to be 15.2% (range 8.3%–38.8%).
- Based on available data, on average, 54.9% of Hepatitis C seropositive persons had detectable Hepatitis C RNA (range 12.1%–86.9%).
- The mean prevalence of Hepatitis C viremia was estimated to be 8.7% of the state prison population (range 1.4%–24.5%).
- Applying the 8.7% viremia prevalence estimate to the total US prison population at year-end 2021, indicates that as many as 91,090 persons incarcerated in prisons need Hepatitis C treatment.
What are the implications for the prevention and control of viral hepatitis?
- The Centers for Disease Control and Prevention (CDC) estimates that from 2013 through 2016, the rate of current Hepatitis C infection among incarcerated persons was at least 10X higher than among persons in the general population, underscoring the necessity of mounting effective Hepatitis C testing and treatment programs in correctional settings.
- Among the best practices recommended for Hepatitis C elimination programs in correctional settings are:
- Universal, opt-out Hepatitis C testing for all incarcerated persons, not just those who disclose risk factors.
- Peer-based education and mentorship to increase uptake of Hepatitis C testing and treatment.
- Efficient models of care that remove barriers and extend provider capacity, such as telemedicine.
- Patient navigators to link infected persons into care after release from jail, where short stays preclude Hepatitis C treatment.
- States seeking a Section 1115 Medicaid waiver to develop and finance inmate pre-release coverage programs should designate hepatitis C as a qualifying condition for eligibility under the waiver and ensure that hepatitis C testing and treatment are covered benefits.
- Although currently not available in the United States, point of care (POC) Hepatitis C RNA testing has been shown to be effective in reducing barriers to Hepatitis C testing and treatment in prisons.