Hepatitis C Infection High Among Inmates, Potentially Successful Interventions Exist, Report FindsHepatitis C infections have reached "epidemic proportions" among incarcerated populations, and increased funding, education and screening efforts are needed to fight the disease, according to the new report Hepatitis C and Incarcerated Populations: The Next Wave for Correctional Health Initiatives, released by the Association of State and Territorial Health Officials. An estimated 1.4 million HCV-infected people are detained in correctional facilities each year, with an inmate HCV rate of 20% to 40%, well above the 2% infection rate in the general U.S. population. Sixty percent of HCV infections are the result of illegal intravenous drug use, a problem particularly acute in correctional centers, where 25% of state inmates and 14% of federal prisoners have histories of injecting drugs. HCV is an "insidious" blood-borne virus with hidden symptoms that produces chronic infections such as liver disease in 85% of those infected and untreated. Although the CDC and NIH have published recommendations for the prevention and control of HCV, they do not address the specific concerns of incarcerated populations, leaving many of these issues "unanswered and unresolved." Many correctional institutions do not routinely screen inmates for HCV, as viral treatment "may not be the priority health concern" if the inmate is co-infected with HIV or presents other morbidities, and because "treatment options are limited" as a result of severe treatment side effects and limited treatment effectiveness. Furthermore, many institutions lack the financial resources for HCV screening, and many inmates will not finish the one-year treatement. The report maintains, however, that "many potentially successful interventions ... could be undertaken," despite the limitations of screening and treatment, such as efforts to educate prisoners on risk factors and the importance of alcohol abstinence, as alcohol can lead to liver cirrhosis in HCV infected people.
The report provides several recommendations, including the following:
- The CDC should develop guidelines specific to preventing and controlling HCV among inmates;
- Funding is needed for community interventions addressing HCV prevention, screening, diagnosis and treatment of at-risk populations before incarceration;
- States should integrate HCV prevention into existing HIV/AIDS programs, family planning programs and STD clinics;
- Additional collaboration is needed between corrections and public health agencies;
- The federal government should lift restriction on the use of funds for needle exchange services.