Establishing an Epidemiologic Profile of Hepatitis C Virus Infection at the Los Angeles County Jail

Abstract

Objective The hepatitis C virus (HCV) is the most common blood-borne infection in the United States. Although 2% to 3% of the global population is estimated to be infected with HCV, an estimated 18% of the US prison population may be infected. The objective of this study was to establish an epidemiologic profile of HCV infection in the largest urban jail system in the United States. Methods We retrospectively analyzed 20 years of data on demographic characteristics, risk factors, and HCV positivity among 80 681 individuals incarcerated at the Los Angeles County Jail who were tested for HCV infection from January 1, 2000, through December 31, 2019. We used multivariate logistic regression analysis to determine predictors of HCV positivity. Results Of the 80 681 individuals tested, 27 881 (34.6%) had positive test results for HCV infection. In the multivariate analysis, HCV positivity was most strongly associated with injection drug use (adjusted odds ratio [aOR] = 34.9; 95% CI, 24.6-49.5) and being born during 1946-1955 (aOR = 13.0; 95% CI, 11.9-14.2). Men were more likely than women to have HCV infection (aOR = 1.4; 95% CI, 1.3-1.5), and Hispanic (aOR = 4.2; 95% CI, 3.9-4.4) and non-Hispanic White (aOR = 3.8; 95% CI, 3.5-4.0) individuals were more likely than non-Hispanic African American individuals to have HCV infection. Noninjection drug use, homelessness, and mental health issues were also significantly associated with HCV positivity. Conclusion Even in the absence of resources for universal screening for HCV infection, the creation of a risk profile and its implementation into a screening program may be a beneficial first step toward improving HCV surveillance and establishing an accurate estimate of HCV infection in the incarcerated population.

Implementation and 12-Month Health Service Utilization and Cost Outcomes from a Managed Care Health Plan's Permanent Supportive Housing Program

“…Adverse impacts of homelessness have been documented in Southern California communities (Abramson, Sanko, and Eckstein, 2021;Qureshi et al, 2021;Salem et al, 2020). For example, a study in 2020 found significantly elevated rates of posttraumatic stress symptoms among formerly incarcerated homeless women in Los Angeles County (Salem et al, 2020).…”

The effect of direct-acting antiviral regimens and telemedicine on the treatment of inmates with hepatitis C virus infection in Israeli prisons

“…Test results for HCV infection were positive in 34.6% but they also included HCV antibody test, and not only detectable HCV RNA or HCV genotype. 10 These rates, however, all exceed the 1% prevalence in the general population 11 and this is due to the higher prevalence of risky behaviors among prisoners. 12 In the past, only a minority of prisoners infected by HCV were tested and treated, mainly because of inaccessible resources, untrained staff, short incarceration time, and the potential interruption of treatment when transferred to the community.…”

“…Test results for HCV infection were positive in 34.6% but they also included HCV antibody test, and not only detectable HCV RNA or HCV genotype. 10 These rates, however, all exceed the 1% prevalence in the general population 11 and this is due to the higher prevalence of risky behaviors among prisoners. 12 …”