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Pilot Program Integrating HCV Screening Into HIV Screening in Incarcerated in Massachusetts: 37.8% (n=531) had an HCV-related test result reported to MAVEN after release, indicating linkage to care
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"This article describes the integrated HCV program developed by MDPH BID with BCSD and the results of the program with respect to case identification and linkage to care"....."with the increase in HCV infection among young people, the low rate of diagnosis in the general population, and the availability of increasingly effective medications, all opportunities to diagnose those at risk and treat people who may not otherwise be engaged in health care must be explored."
"The initiative has demonstrated that integration of HCV education and screening is feasible in a county correctional setting with an existing HIV screening program, and that HCV screening is generally well accepted by inmates and detainees in the context of short-term incarceration and detention. It is important to highlight that the program's success was attributable to numerous factors, including strong institutional support and adequate state funding. Although these factors may vary significantly across state jurisdictions, strategies for communication, service development, and program development could be replicated. short-term incarceration and detention. It is important to highlight that the program's success was attributable to numerous factors, including strong institutional support and adequate state funding. Although these factors may vary significantly across state jurisdictions, strategies for communication, service development, and program development could be replicated.
Screening this population for HCV infection yielded high seropositivity rates (20.5%) and identified young adults who were more likely to have been recently exposed than their older counterparts. However, the surveillance data we examined, while limited, indicate that only 37.8% of HCV antibody-positive former inmates and detainees who were given a referral followed up with HCV clinical care post-release. The data also indicate that follow-up often occurred more than six months after release. The initiative also served to reengage 43 individuals who had previously tested positive for HCV antibody. This percentage represents 35% of individuals testing positive through the initiative and indicates that incarceration represents an opportunity for reengagement in care and treatment as well as diagnosis of new infections.
Because HCV testing was built upon, and integrated into, a functional HIV program, the costs of this initiative were low. The additional costs were for specimen collection, shipping, and testing; a moderate increase in personnel time to administer education, testing, and linkage activities; and the purchase of hepatitis A and B vaccine. Hepatitis A and B vaccination is available throughout the county system and at BCSD as part of the integrated system. While testing for tuberculosis and sexually transmitted infections is part of basic medical services and not part of the integrated program, integration of these additional services is worth exploring."
"This article describes the integrated HCV program developed by MDPH BID with BCSD and the results of the program with respect to case identification and linkage to care.......Activities to address HIV prevention and screening of inmates have been evaluated, and recommendations for routine, opt-out HIV testing in correctional settings exist.2-4 The prevalence of hepatitis C virus (HCV) infection among inmates in the United States is substantially higher than that of HIV infection, ranging from 12% to 35%, and up to one-third of those with HCV infection have passed through a correctional facility; however, HCV testing is not routinely provided in correctional facilities.......Given recent trends in HCV infection, it is imperative to identify innovative ways to test those at risk of infection and to ensure that those infected are linked to appropriate care.....Given recent trends in HCV infection, it is imperative to identify innovative ways to test those at risk of infection and to ensure that those infected are linked to appropriate care. The MDPH Bureau of Infectious Disease (BID) began an integrated HCV screening and education pilot project at the Barnstable County Sheriff's Department (BCSD), described in this article, which leveraged resources that were in place for HIV services......In July 2009, BID began an HCV screening and education pilot project at BCSD. The Screening for Hepatitis C as a Prevention Enhancement (SHAPE) initiative provided hepatitis and liver health education, HCV antibody testing, and referral to community-based clinical providers upon release for HCV antibody-positive individuals......This model was limited to screening; treatment for HCV is not provided by BCSD and is only rarely provided at any county facility in the state. The ID coordinator made referrals to health care for those HCV antibody-positive inmates who were soon to be released from BCSD. BCSD primarily worked with a community health center, Duffy Health Center, and the Infectious Disease Clinical Services (IDCS) of Cape Cod Healthcare......HIV education, screening, and linkage-to-care services have been ongoing at 12 county jails, including BCSD, for more than 15 years.....in July 2009, HCV screening was implemented......BID employs the Massachusetts Virtual Epidemiologic Network (MAVEN), a secure, Web-based integrated disease surveillance and case-management system. For HCV surveillance, all positive laboratory test results are reportable to MDPH by name. These data are received both electronically and via paper reports for manual data entry into MAVEN. Case follow-up includes sending case report forms to ordering providers for additional patient data; for suspect acute HCV infection.....cases, further investigation is conducted by local health departments. Cases of HCV infection in MAVEN may be updated as additional laboratory test results and other related data are received over time. Test types and results are documented in MAVEN......From July 1, 2009, through December 31, 2011, BCSD offered HCV and HIV testing to 2,716 inmates and detainees, with an acceptance rate of 21.9% for HCV (n5596) and 24.6% for HIV (n5667). There were nearly 7,000 bookings at BCSD during this time. Among those tested for HCV, 20.5% were antibody-positive (n5122)......Among the 122 inmates identified as positive for HCV antibody, 48.4% were aged 20-29 years and 82.8% were non-Hispanic white; 91.0% reported a history of injection drug use......37.8% (n=531) had an HCV-related test result reported to MAVEN after release, indicating linkage to care; of these, 74.2% (n=523) had a positive RNA-based test (qualitative or quantitative nucleic acid amplification test or a report of genotype), confirming infection."
"The delayed follow-up care in the community suggests that, even for those seen by clinicians upon release, not all participants received appropriate supplementary testing despite the availability of MDPH-funded HCV medical management programs in the targeted community and the increased availability of health insurance resulting from Massachusetts's health-care reform. Confirmatory viral RNA testing may need to be offered within the correctional facility to ensure complete diagnostic testing for current infection. Further, these results indicate that additional support for inmates at the time of release may be needed to ensure linkage to medical care. This type of service is provided in Massachusetts and other jurisdictions for people with HIV infection; expansion of state-funded corrections-to-community programs for those mono-infected with HCV should be explored.
While screening in the correctional setting has been recommended by CDC, the Institute of Medicine, and others,6,14-16 and the data from this pilot clearly indicate that there can be a high yield from such programs, there can be hesitation to adopt the program due to the costs associated with HCV care and treatment. Confirmatory testing and HCV disease staging may not be factored into correctional health medical budgets, and currently available antiviral treatments may cost $20,000-$65,000 per patient. Short stays in county facilities make it difficult, if not impossible, to initiate evaluation and complete antiviral treatment, with assurance of continuity of care upon release. However, with the increase in HCV infection among young people,11 the low rate of diagnosis in the general population,6,7 and the availability of increasingly effective medications, all opportunities to diagnose those at risk and treat people who may not otherwise be engaged in health care must be explored.
CONCLUSION
The SHAPE initiative has demonstrated that targeting correctional facilities for integrated HIV and HCV screening, with sufficient infrastructure and support from within the facility, can be an efficient and high-yield endeavor. While such a program may require modification and be difficult to implement in other states and facilities, our findings lend support to the feasibility of successful integration programs in correctional settings. Expansion of this program model would provide increased opportunities for education, testing, and linkage to care."
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Screening for Hepatitis C as a Prevention Enhancement (SHAPE) for HIV: An Integration Pilot Initiative in a Massachusetts County Correctional Facility
Public Health Reports / 2014 Supplement 1 / Volume 129
Noelle Cocoros, DSc, MPHa, Eduardo Nettle, BAa , Daniel Church, MPHa, Lori Bourassa, PhD, MPHa, Vicki Sherwin, BSb , Kevin Cranston, MDiva
Robert Carr, MEda, H. Dawn Fukuda, ScMa, Alfred DeMaria, Jr., MD
aaMassachusetts Department of Public Health, Bureau of Infectious Disease, Jamaica Plain, MA
bBarnstable County Sheriff's Department, Bourne, MA
ABSTRACT
Objectives. The Massachusetts Department of Public Health (MDPH) and the Barnstable County Sheriff's Department (BCSD) in Massachusetts initiated a pilot program in July 2009 offering education and hepatitis C virus (HCV) antibody testing to inmates and detainees, concurrent with routine HIV testing. The initiative was implemented to assess the feasibility of integrating HCV screening into an HIV screening program in a correctional setting and the efficacy of linking HCV antibody-positive inmates to clinical care upon release.
Methods. Through the Screening for Hepatitis C as a Prevention Enhancement initiative, HCV and HIV testing were offered to inmates and detainees shortly after admission, and by request at any time during incarceration. In preparation for release, referrals were made to community-based medical providers for HCV follow-up care. Data from BCSD were compared with routine surveillance data received by MDPH. Confirmatory HCV test results received by April 15, 2012, were considered indicators of appropriate post-release clinical care.
Results. From July 2009 through December 2011, 22% (n5596) and 25% (n5667) of 2,716 inmates/detainees accepted HCV and HIV testing, respectively. Of those tested for HCV antibody, 20.5% (n5122) were positive. Of those tested for HIV antibody, 0.8% (n55) were positive. Of the inmates who tested HCV positive at BCSD and had been released, 37.8% were identified as receiving post-release medical care.
Conclusions. We determined that integration of HCV education and screening into correctional facilities is feasible and reveals high rates of HCV infection. Although this model presupposes programmatic infrastructure, elements of the service design and integration could inform a range of correctional programs. Effective linkage to care, while substantial, was not routine based on our analysis, and may require additional resources given its cost and complexity.
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