Adopting More Systematic Approaches to Hepatitis C Treatment in Correctional Facilities

Hepatitis C virus (HCV) is the most common bloodborne virus in the United States: Approximately 2% of the adult population is infected with HCV. Although incidence of HCV infection has declined since the late 1980s, most infections remain undiagnosed and screening continues to increase. Diagnosed cases are expected to increase fourfold between 1990 and 2015 (1).

The prevalence of HCV infection is particularly high in injection drug users (72% to 86%) and, among all racial/ethnic groups, is highest in African Americans (6%) (1, 2). These subpopulations are over-represented among correctional inmates; thus, it is not surprising that a disproportionate burden of HCV infection occurs in people who pass through correctional facilities. According to a recent estimate, between 29% and 43% of all people infected with HCV in the United States are released from a prison or jail during a given year (3).

Periods of incarceration in correctional facilities offer important opportunities to diagnose, treat, and prevent many health problems, including HCV infection (4). Because of the heavy concentration of HCV-infected people among inmates, correctional facilities may be the settings in which those in need of HCV interventions may be most efficiently reached (5). In a recent consensus statement and forthcoming guidelines, the National Institutes of Health (NIH) (1) and the Centers for Disease Control and Prevention (6) recognize the importance of expanded and improved HCV interventions in prisons and jails.

In this issue, Allen and colleagues use their clinical experience in the Rhode Island Department of Corrections to demonstrate …