Sabrina A Assoumou1, Jianing Wang2, Abriana Tasillo2, Golnaz Eftekhari Yazdi2, Judith I Tsui3, Lara Strick4, Benjamin P Linas5. 1. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. Electronic address: sabrina.assoumou@bmc.org. 2. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts. 3. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington. 4. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington; Washington State Department of Corrections, Tumwater, Washington. 5. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts.
Abstract
INTRODUCTION: There is no widely accepted testing approach for hepatitis C virus infection in correctional settings, and many U.S. prisons do not provide routine testing. The aim of this study was to determine the most effective hepatitis C virus testing strategy in one U.S. state prison and describe the population with reactive testing. METHODS: A retrospective analysis was performed using individuals entering the Washington State prison system, which routinely offers hepatitis C virus testing, to compare routine opt-out with current recommendations for risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized using aspartate aminotransferase to platelet ratio index and Fibrosis-4 index. Analyses were conducted in 2017. RESULTS: Between 2012 and 2016, a total of 24,567 (83%) individuals were tested for the hepatitis C virus antibody and 4,921 (20%) were reactive (test was positive). There were 2,403 (49%) that had hepatitis C virus RNA testing, with 1,727 (72%) showing chronic infection. Reactive antibody was more prevalent in individuals born between 1945 and 1965 compared with other years (44% vs 17%); however, most cases (72%) were outside of this cohort. Up to 35% of positive reactive tests would be missed with testing targeted by birth cohort and risk behavior. Of chronically infected individuals, 23% had at least moderate liver fibrosis. CONCLUSIONS: Targeted testing in the Washington State prison system missed a substantial proportion of hepatitis C virus cases; of those with reactive testing, a sizeable proportion of people had at least moderate liver disease, placing them at risk for complications. Routine testing at entry should be considered by U.S. state prisons.
INTRODUCTION: There is no widely accepted testing approach for hepatitis C virus infection in correctional settings, and many U.S. prisons do not provide routine testing. The aim of this study was to determine the most effective hepatitis C virus testing strategy in one U.S. state prison and describe the population with reactive testing. METHODS: A retrospective analysis was performed using individuals entering the Washington State prison system, which routinely offers hepatitis C virus testing, to compare routine opt-out with current recommendations for risk-based and one-time testing for individuals born between 1945 and 1965. Additionally, liver fibrosis stage was characterized using aspartate aminotransferase to platelet ratio index and Fibrosis-4 index. Analyses were conducted in 2017. RESULTS: Between 2012 and 2016, a total of 24,567 (83%) individuals were tested for the hepatitis C virus antibody and 4,921 (20%) were reactive (test was positive). There were 2,403 (49%) that had hepatitis C virus RNA testing, with 1,727 (72%) showing chronic infection. Reactive antibody was more prevalent in individuals born between 1945 and 1965 compared with other years (44% vs 17%); however, most cases (72%) were outside of this cohort. Up to 35% of positive reactive tests would be missed with testing targeted by birth cohort and risk behavior. Of chronically infected individuals, 23% had at least moderate liver fibrosis. CONCLUSIONS: Targeted testing in the Washington State prison system missed a substantial proportion of hepatitis C virus cases; of those with reactive testing, a sizeable proportion of people had at least moderate liver disease, placing them at risk for complications. Routine testing at entry should be considered by U.S. state prisons.
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