Testing all entering prison inmates for hepatitis C and providing treatment for those with at least a year remaining in their sentence would improve health outcomes but would require a major investment within corrections systems, a study led by a Boston Medical Center physician concludes.
Published in the journal Clinical Infectious Diseases, the study simulated the lifetime progression of a cohort of prisoners from intake until death. The simulation considered various levels of hepatitis C testing and various scenarios for treatment being provided in prison or upon release. The researchers found that the most effective strategy involved testing all inmates, treating those with at least 12 months remaining in their sentence, and linking those with shorter remaining sentences to care upon their release.
This strategy resulted in a 23% increase in hep C cure rate and a 54% reduction in cirrhosis cases, while increasing life expectancy for individuals with hep C. Previous research has questioned corrections policies that have based testing and treatment decisions largely on individual illness and risk profiles.
The researchers found that the approach of “test all, treat all” was more cost-effective than typical current practice, but added that it would require an annual cost of $1.440 per entering inmate for corrections systems.
“Addressing HCV in prisons will require investment from departments of corrections and public health departments, but we hope these findings demonstrate the value of such an investment and will encourage innovations in financing HCV care among this population,” said Sabrina Assoumou, MD, MPH, lead author of the study and an infectious disease physician at Boston Medical Center.