Comparison of Risk-Based Hepatitis C Screening and the True Seroprevalence in an Urban Prison System

• Published in: Journal of urban health Vol. 92; no. 2; pp. 379 - 386
• Main Authors: Kuncio, Danica E., Newbern, E. Claire, Fernandez-Viña, Marcelo H., Herdman, Bruce, Johnson, Caroline C., Viner, Kendra M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2015; Springer Nature B.V
• Subjects: Adult; Age Factors; Comparative studies; Epidemiology; Female; Health Informatics; Hepatitis; Hepatitis C - epidemiology; Hepatitis C Antibodies; Hepatitis C virus; Humans; Male; Mass Screening - methods; Medical screening; Medicine; Medicine & Public Health; Philadelphia; Prisoners; Prisons; Prisons - statistics & numerical data; Public Health; Risk Factors; Seroepidemiologic Studies; Sex Factors; Urban areas; Urban Health; Philadelphia; USA, Pennsylvania, Philadelphia; USA; Hepatitis C virus; Correctional health; Testing strategies
• ISSN: 1099-3460; 1468-2869
• DOI: 10.1007/s11524-015-9945-4

Hepatitis C virus (HCV) is the most common blood-borne infection in the USA, though seroprevalence is elevated in certain high-risk groups such as inmates. Correctional facility screening protocols vary from universal testing to opt-in risk-based testing. This project assessed the success of a risk-based HCV screening strategy in the Philadelphia Prison System (PPS) by comparing results from current testing practices during 2011–2012 (Risk-Based Screening Group) to a September 2012 blinded seroprevalence study (Philadelphia Department of Public Health (PDPH) Study Cohort). PPS processed 51,562 inmates in 2011–2012; 2,727 were identified as high-risk and screened for HCV, of whom 57 % tested HCV antibody positive. Twelve percent ( n  = 154) of the 1,289 inmates in the PDPH Study Cohort were anti-HCV positive. Inmates ≥30 years of age had higher rates of seropositivity in both groups. Since only 5.3 % of the prison population was included in the Risk-Based Screening Group, an additional 4,877 HCV-positive inmates are projected to have not been identified in 2011–2012. Gaps in case identification exist when risk-based testing is utilized by PPS. A more comprehensive screening model such as opt-out universal testing should be considered to identify HCV-positive inmates. Identification of these individuals is an important opportunity to aid underserved high-risk populations and to provide medical care and secondary prevention.