New Opportunities for the Management and Therapy of Hepatitis C in Correctional Settings

Abstract

Hepatitis C in prison populations is now a major public health problem, and large numbers of correctional facilities have no comprehensive management program, often because of formidable projected costs and tightening budget constraints. The North Dakota Department of Corrections and Rehabilitation has operated a management and therapy program since 2002 using consensus interferon and ribavirin with 45% cost savings. The program has provided excellent sustained viral responses: 54.2% for genotype 1 hepatitis C, 75% for genotypes 2 and 3, and 63.6% overall.

Lack of Health Insurance Limits the Benefits of Hepatitis C Virus Screening: Insights from the National Health and Nutrition Examination Hepatitis C Follow-Up Study

“…It does not include some high-risk groups such as the homeless or incarcerated. It is worth noting that while there is advocacy for treating HCV in correctional facilities, none exist for homeless individuals ( 36,37 ). Th e exact impact of the new direct acting anti-viral agents on decisions or motivation to pursue HCV treatment cannot be accurately determined at this point given that these drugs have only been recently available and continue to evolve.…”

Developing blood borne virus services across prisons in Wales, UK

“…Many countries have produced strategies to reduce BBV transmission and improve access to testing and treatment all of which address the need to target custodial settings (The Scottish Government, 2008;Australian Government, 2010;Colvin and Mitchell, 2010; US Department of Health and Human Services, 2010;Ontario Hepatitis C Task Force, 2009). Prisons house individuals at high risk of BBVs due to many prisoners having a history of intravenous drug use (IVDU; Martin et al, 2010;Flanigan et al, 2010;Almasio et al, 2011). Many challenges exist to delivering health services in prisons such as the often complex health needs of prisoners and the rapid turnover of prisoners in remand settings (Moller and Stover, 2007;Rice et al, 2012;Ginn, 2012).…”

“…However, treatments can be complex and many patients experience side effects which may include impact on mental health therefore prisons must have adequate support mechanisms in place before initiating treatment. Treatment for hepatitis B and C has been shown to be cost effective in preventing long term costs of treating liver cirrhosis and cancer (Salomon et al, 2003;Sutton et al, 2006;Tan et al, 2008;Martin et al, 2010).…”

“Seek, test, treat and retain” for hepatitis C in the United States criminal justice system

“…Access to treatment has thus been restricted to those inmates with longer sentences (e.g. at least 20 months remaining to serve – Martin et al ., 2010) so as to allow for treatment completion and follow-up. Psychiatric comorbidity may be listed as a relative or absolute contraindication to HCV therapy in correctional protocols, despite evidence that mentally ill prisoners can be treated safely (Allen et al ., 2003).…”