Universal opt-out screening for hepatitis C virus (HCV) within correctional facilities is an effective intervention to improve public health

Abstract

PurposeWorldwide efforts to identify individuals infected with the hepatitis C virus (HCV) focus almost exclusively on community healthcare systems, thereby failing to reach high-risk populations and those with poor access to primary care. In the USA, community-based HCV testing policies and guidelines overlook correctional facilities, where HCV rates are believed to be as high as 40 percent. This is a missed opportunity: more than ten million Americans move through correctional facilities each year. Herein, the purpose of this paper is to examine HCV testing practices in the US correctional system, California and describe how universal opt-out HCV testing could expand early HCV detection, improve public health in correctional facilities and communities, and prove cost-effective over time.Design/methodology/approachA commentary on the value of standardizing screening programs across facilities by mandating all facilities (universal) to implement opt-out testing policies for all prisoners upon entry to the correctional facilities.FindingsCurrent variability in facility-level testing programs results in inconsistent testing levels across correctional facilities, and therefore makes estimating the actual number of HCV-infected adults in the USA difficult. The authors argue that universal opt-out testing policies ensure earlier diagnosis of HCV among a population most affected by the disease and is more cost-effective than selective testing policies.Originality/valueThe commentary explores the current limitations of selective testing policies in correctional systems and provides recommendations and implications for public health and correctional organizations.

A simple risk-based strategy for hepatitis C virus screening among incarcerated people in a low- to middle-income setting

“…Studies on the e cacy of a risk-based HCV strategy among marginalized populations are limited, and to date, case nding by surveys have been only done in high-income countries (18,19). Previous studies have shown bene ts for universal screening in correctional facilities, compared to the risk-based screening, which is in contrast to our ndings (18,24). A possible explanation could be that in Iran, no taboo exists around illicit drug use among the incarcerated population, which results in more reliable self-reported information (25).…”

Harm reduction and viral hepatitis C in European prisons: a cross-sectional survey of 25 countries

“…In the UK, universal opt-out screening has been initiated as of 2015 in Scotland, 2016 in Wales, and April 2017 in England, and this will be expanded to all prisons in the coming years [ 40 ]. This is crucial, as a significantly higher uptake of testing has been shown to occur with opt-out procedures in prisons [ 41 – 43 ]. Furthermore, several trials have shown that improved screening with opt-out procedures and subsequent treatment with DAAs is cost-effective, despite the high costs of DAA treatments [ 44 , 45 ].…”

Barriers and facilitators to hepatitis C (HCV) screening and treatment—a description of prisoners’ perspective

“…This research found an inconsistent approach to HCV screening with many prisoners only being tested at their own request. Consideration should be given to introducing an opt-out screening program on committal to prison in Ireland [ 18 , 40 , 41 ]. This screening strategy has been shown to be cost effective and has the potential to reduce HCV transmission and HCV-related liver disease primarily in the community [ 40 , 42 ].…”