A Framework for Management of Hepatitis C in Prisons

16 May 2006 | Volume 144 Issue 10 | Pages 762-769

The prevalence of chronic hepatitis C virus (HCV) infection in prisons ranges from 12% to 31%. There are generally accepted—albeit still evolving—guidelines for identification and treatment of hepatitis C in the community. However, there is less agreement among health professionals caring for prisoners about best practices for identification, medical management, and treatment of hepatitis C. Inmates often lack health care before incarceration. In prisons, infected persons could be identified and the management of infection initiated; however, the high prevalence of HCV infection among prisoners would impose a disproportionate cost for hepatitis C care on the correctional system. The optimal solution is for prison and public health systems in the United States to jointly provide targeted HCV testing and standard-of-care hepatitis C medical management, treatment, and prevention programs to prison inmate populations. The authors report on a January 2003 meeting of experts in prison health, public health, hepatology, and infectious diseases and explore the clinical care, prevention, and collaboration needed to provide hepatitis C management in prisoners.

Author and Article Information

From Centers for Disease Control and Prevention, Atlanta, Georgia; University of Texas Medical Branch, Galveston, Texas; Virginia Commonwealth University Health System, Richmond, Virginia; and National Institutes of Health, Bethesda, Maryland.

Acknowledgments: The authors thank the following people for providing the planning group with the correctional professional viewpoint: James Gondles, American Correctional Association; Edward Harrison, National Commission on Correctional Health Care; Timothy Ryan, American Jail Association; and Richard Stalder, Association of State Correctional Administrators. The authors also thank Keith Bordelon, Centers for Disease Control and Prevention, and Samantha McCready and Carol Schagunn, University of Minnesota, for contributions to the coordination and planning of the January 2003 meeting in San Antonio, Texas.

Potential Financial Conflicts of Interest: Consultancies: D.T.-Y. Lau (Roche, GlaxoSmithKline, Bristol-Myers Squibb); Expert testimony: A.C. Spaulding (Dr. Spaulding has given expert testimony on prisoners' right to receive medical management of hepatitis C); Honoraria: D.T.-Y. Lau (Bristol-Myers Squibb, Roche, GlaxoSmithKline); Grants received: D.T.-Y. Lau (GlaxoSmithKline, Bristol-Myers Squibb, Roche), R. Sterling (Schering-Plough, Roche); Grants pending: R. Sterling (Roche, Schering-Plough).

Requests for Single Reprints: Anne C. Spaulding, MD, MPH, Rollins School of Public Health of Emory University, Department of Epidemiology, 1518 Clifton Road NE, Atlanta, GA 30322; e-mail, aspauld{at}emory.edu.

Current Author Addresses: Dr. Spaulding: Rollins School of Public Health of Emory University, Department of Epidemiology, 1518 Clifton Road NE, Atlanta, GA 30322.

Dr. Weinbaum: Centers for Disease Control and Prevention, 1500 Clifton Road MS G37, Atlanta, GA 30333.

Dr. Lau: University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555.

Dr. Sterling: Virginia Commonwealth University Health System, 1200 East Broad Street, Room 1454, Richmond, VA 23298.

Drs. Seeff and Hoofnagle: National Institutes of Health, 31 Center Drive, Bethesda, MD 20892.

Dr. Margolis: International Vaccine Institute, SNU Research Park, San 4-8 Bongeheon-7-dong, Seoul, Korea 151-818.