The benefits of screening prison inmates for infection with the hepatitis C virus (HCV) and treating those who test positive for the infection would extend far beyond the prison population, according to projections made by investigators from Massachusetts General Hospital (MGH) and the University of Pittsburgh Graduate School of Public Health. In a report published in Annals of Internal Medicine, the research team describes how their simulation found that a prison-based screening and treatment program could reduce HCV transmission in the general community and would be highly cost effective over the long run.
“In addition to reducing the transmission of HCV after prisoners are released, universal HCV testing and treatment in prisons would reduce outcomes of advanced HCV – such as liver cancer, end-stage liver disease and death – among prisoners,” says Jagpreet Chhatwal, PhD, of the MGH Institute for Technology Assessment, senior author of the report. “We now have highly effective treatments for HCV, so we wanted to know the impact of providing routine testing and treatment to inmates, a group in which the infection is highly prevalent.”
Among individuals with a history of incarceration, HCV infection is primarily transmitted by the use of injected drugs. It is the leading cause of liver cancer, and HCV-associated liver failure the most common situation requiring a liver transplant. While about 1 percent of the general U.S. population is infected with HCV, more than 17 percent of prisoners are infected. HCV-associated liver disease is a frequent cause of death among prisoners, recently surpassing HIV infection. In recent years several drugs capable of eradicating HCV infection in more than 90 percent of patients have become available, but they are quite costly, which could discourage their use in state and federal prisons that have limited budgets for inmate health care.