Rich Feffer, Hepatitis Education Project
Rich Feffer, Hepatitis Education Project
A disproportionate number of people with hepatitis C (HCV) in the U.S. are or have been inmates in jails and prisons. Correctional settings therefore present significant opportunities to provide hepatitis prevention, testing, care, and treatment interventions. To help incarcerated people understand HCV, the National Hepatitis Corrections Network (NHCN) has introduced a new resource to assist with inmate education efforts.

Hepatitis C and Incarcerated Individuals
According to the most recent data from the U.S. Department of Justice, 2.2 million people were incarcerated in prisons or jails in the U.S. in 2013.  The prevalence of hepatitis C is high among persons who are incarcerated, with studies estimating rates that range from 10% to more than one-third. These rates are significantly higher than the estimated HCV prevalence in the overall U.S. population, which ranges from 1 to 2%.

A history of high-risk behaviors prior to incarceration, including injection drug use and unsafe tattooing, is an important contributor to high prevalence among correctional populations. High-risk behaviors during periods of incarceration (e.g., shared needles and tattooing equipment, exposure to infected blood) are also associated with transmission of hepatitis C.

Since over 90% of individuals in jail or prison will be released back to the community in the future, addressing hepatitis C within corrections settings is an excellent opportunity to promote public health by increasing awareness, reducing transmission, and improving hepatitis-related outcomes, both during and after incarceration.

In recognition of these circumstances and as part of the nation’s response to viral hepatitis, the Viral Hepatitis Action Plan calls for expanding access to and delivery of hepatitis prevention, care, and treatment services in correctional settings as an important step in reaching the nation’s viral hepatitis goals. The Action Plan details activities that both federal and non-federal stakeholders can take to improve access to viral hepatitis prevention, care and treatment services in correctional settings.

HCV Educational Tool for Incarcerated People
One of the nonfederal stakeholders working to address this issue is the National Hepatitis Corrections Network (NHCN), an initiative of the Seattle-based Hepatitis Education Project (HEP). NHCN recently released a new booklet,“Hepatitis C in Prison or Jail,” a collaboration between HEP and Los Angeles-based The Center for Health Justice.

The 2-page booklet is tailored to incarcerated individuals and covers a variety of facts and recommendations related to hepatitis C, including:   
  • An introduction to hepatitis C   
  • How hepatitis C is transmitted and how it is not transmitted   
  • Viral hepatitis services that may be available in jails and prisons including testing, vaccinations (hepatitis A and B), and curative treatments for hepatitis C   
  • Recommendations for maintaining liver health   
  • Recommendations for incarcerated persons who do not have current access to hepatitis C treatment
The NHCN supports a public health approach to hepatitis C management in corrections. It provides a forum for its partners, who include a diverse group of stakeholders, to discuss hepatitis education, prevention, testing, and treatment in correctional facilities. The “Hepatitis C in Prison and Jail” booklet can be an effective tool in increasing awareness of hepatitis C among prison and jail inmates. It provides specific actions they can take to decrease their risk of transmission of hepatitis C or take charge of their health if they are infected.

Federal Bureau of Prisons Updates Hepatitis C Treatment Guidelines
Also of potential interest to nonfederal stakeholders working in this arena, in July 2015, the Federal Bureau of Prisons released updated clinical practice guidelines for the Evaluation and Management of Chronic Hepatitis C Virus Infection to support management of hepatitis C within the federal prison system. State and local correctional health services often look to these guidelines when developing hepatitis C testing and treatment policies, although specific policies may vary significantly across states and types of correctional institutions. Regardless, the relatively recent Food and Drug Administration approvals of all-oral treatments that can cure most patients of hepatitis C infection offer new tools to address hepatitis C in correctional settings.

Due to variations in hepatitis C management policies, not all incarcerated people with hepatitis C currently have access to treatment during their incarceration; however, even without treatment, opportunities remain within correctional health settings to provide education on how to prevent transmission to others and support liver health until treatment becomes available. Given the large number of people with hepatitis C in our prisons and jails, most stakeholders recognize the public health opportunities available in these settings. That said, more work is needed to understand current policies and practices, identify best practices, and build capacity to test for and treat viral hepatitis in corrections. Doing so has the potential to greatly improve community health and reduce the overall burden of viral hepatitis in the United States.

Rich Feffer, MS, CCHP, is the Correctional Health Programs Manager at the Hepatitis Education Project. This article was first published at AIDS.gov.