An estimated 3.5 million people in the U.S. are living with hepatitis C virus (HCV), the leading cause of liver failure and hepatocellular carcinoma. (1) Prevalence of HCV in U.S. prisons is up to 20 times higher than in the general population. (2) Liver disease was the third-ranking cause of death among the U.S. prison population in 2012 and has been associated with rising death rates after incarceration. (3) Highly effective treatment is available and can prevent HCV-related morbidity and mortality, and HCV treatment in the prison population has been demonstrated as cost-effective to society. (4)
Based on national data that people born from 1945-1965, or baby boomers, account for the majority of HCV infections and HCV-associated deaths, the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force issued recommendations in 2012 calling for a one-time HCV test in this age group. In 2015, the Wisconsin Department of Corrections (WDOC) conducted an evaluation and found 25 percent of baby-boomer prison entrants to have evidence of HCV infection (HCV antibody positive); this was the highest rate compared to 13 percent of those born between 1966-1984 and 8 percent of those born in 1985 or after. (5) Furthermore, one-third of baby-boomer entrants did not have previous record of HCV infection in the statewide surveillance system, indicating the first time they were diagnosed with HCV was at intake to prison. (6) As a result of the evaluation, beginning in 2015, WDOC added "birth year during 1945-1965" to risk-based HCV screening criteria that was already in place at intake to prison.
Of interest was the HCV test status of baby boomers admitted to a Wisconsin correctional facility prior to the addition of the intake screening criteria in 2015. This worked to 1) identify inmates in this birth cohort who have not been tested by WDOC and are in the recommended birth cohort for HCV testing, and 2) deliver a community standard of care, including follow-up testing and evaluation for HCV treatment, among inmates.
Approach to the study
Laboratory-based screening for HCV infection begins with a test for HCV antibody. If the antibody test is positive, a ribonucleic acid (RNA) test is necessary to distinguish chronic HCV infection from those whose infection has resolved. A positive test for HCV RNA indicates a chronic HCV infection. The WDOC, the Wisconsin State Laboratory of Hygiene (WSLH) and the Wisconsin Division of...