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 “Hepatitis C Epidemiology in a Large Urban Jail: A Changing Demographic.” Hoff E, Warden A, Taylor R, Nijhawan A. Public Health Reports. 2022.
What question(s) does this study address?
In the United States and in other countries around the world, people who are incarcerated have a higher hepatitis C prevalence compared to the general population. Many have a history of injection drug use and because drug use is illegal in most countries, they often end up in correctional settings. A recently published systematic review reported hepatitis C antibody prevalence in U.S. correctional settings ranging from 3.0%—34.6% with rates of RNA positivity (meaning current, active infection) ranging from 5.2% to 13.6%. Compare these figures to the most recent NHANES (National Health and Nutrition Examination Survey) estimate (January 2017—March 2020) that 0.9% of civilian, noninstitutionalized adults in the U.S. have current hepatitis C virus infection (i.e., hepatitis C RNA positive).
In this retrospective analysis of 4 cycles of opt-out hepatitis C testing in a large urban jail (Dallas County, Texas), Hoff and her fellow investigators sought to determine the prevalence and incidence of hepatitis C antibody positivity and evaluate the demographic characteristics of people who were found to be antibody positive.
What are the major findings of this report/article?
- From June 2015 through December 2019, universal opt-out hepatitis C testing was offered to anyone undergoing a routine blood test at the Dallas County Jail (N= 14,490).
- The investigators report that more than 80% of people accepted hepatitis C testing.
- After removing 1,234 duplicate hepatitis C antibody tests (during the same jail stay and testing year), 13,256 unique hepatitis C antibody test results were analyzed.
- 7% (2,209) of the tests were hepatitis C antibody positive, 83% (11,003) were negative and 3.3% (44) were indeterminate.
- Hepatitis C antibody positivity was significantly associated with older age, female sex, and non-Hispanic White versus non-Hispanic Black race. However, hepatitis C antibody positive people born in 1965 or earlier, were more frequently non-Hispanic Black men.
- In April 2017, confirmatory reflex hepatitis C RNA testing was implemented and of the 1,468 hepatitis C antibody positive specimens tested, 75.3% (1106) were RNA positive.
- 1,185 unique individuals were tested during multiple testing cycles (i.e., people leaving and returning to jail) and 16 of these seroconverted from hepatitis C antibody negative to hepatitis C antibody positive.
What are the implications for the prevention and control of viral hepatitis?
- The high prevalence of hepatitis C antibody positivity and hepatitis C RNA positivity make a strong case for universal hepatitis C testing, prevention counseling, and referral to care in correctional settings.
- Models evaluating widespread testing for hepatitis C in U.S. prisons and treatment for those infected have been found to be cost effective and could lead to improved population health outcomes, including substantial reductions in cirrhosis and its associated costs.
- Both the AASLD (American Association for the Study of Liver Diseases) and the IDSA (Infectious Diseases Society of America) recommend universal opt-out testing for hepatitis C in both jails and prisons, but existing data indicate that only a minority of correctional facilities in the U.S. have implemented these recommendations.
- A recent independent analysis published by STAT suggests that more than 1,000 U.S. prison inmates died from complications of untreated hepatitis C infections in the six years after a curative drug treatment was approved by the FDA in late 2013.