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Hepatitis C virus (HCV) is highly prevalent in the United States, yet is largely culturally invisible. This study examines what people know about their illness, both before and after diagnosis, and the relationship to race. The data are from in-depth interviews in 2004 with 53 persons, mostly white or African American, with HCV in the southeastern United States. The respondents have varying educational backgrounds, family incomes, and possible modes of transmission of HCV. Regardless of whether the diagnosis of HCV came as a surprise, respondents had a range of reactions including fear, shock, sadness, and ambivalence. Knowledge of the disease postdiagnosis varies as some people have expert knowledge, moderate knowledge, or inaccurate to no knowledge of the disease. Minority respondents have less knowledge of HCV than whites. This racial disparity in knowledge has profound implications for people with HCV and the larger society.

The study examines health care inequities in viral load testing among hepatitis C (HCV) antibody-positive patients. The analysis predicts whether individual and census tract sociodemographic characteristics impact the likelihood of viral load testing.

This a study of 26,218 HCV antibody-positive patients in Orange County, California, from 2010 to 2020. The case data were matched with the 2017 American Community Survey to help understand the role of neighborhood socioeconomic characteristics in testing for viral load. Multivariable logistic regression was used to predict the probability of ever testing for HCV viral load.

Thirty-six percent of antibody-positive persons were never viral load tested. The results show inequalities in viral load testing by sociodemographic factors. The following groups were less likely to ever test for viral load than their counterparts: (1) individuals under 65 years old, (2) females, (3) residents of census tracts with lower levels of health insurance enrollment, (4) residents of census tracts with lower levels of government health insurance, and (5) residents of census tracts with a higher proportion of non-white residents.

This is a secondary database from public health department reports. Using census tract data raises the issue of the ecological fallacy. Detailed medical records were not available. The results of this study emphasize the social inequality in viral load testing for HCV. These groups are less likely to be treated and cured, and may spread the disease to others.

This chapter is unique as it combines routinely collected public health department data with census tract level data to examine social inequities associated with lower rates of HCV viral load testing.

Hepatitis C is one of the major health issues in both developed and developing countries. Hepatitis C virus (HCV) infection is more common in prisoners than in the general population. The purpose of this study was to determine the prevalence of HCV and its associated risk factors in Iranian male prisoners in Tehran.

In this cross-sectional study, the authors investigated the frequency and risk factors of hepatitis C infection among male prisoners in the Great Tehran Prison. Information on risk factors including the length of imprisonment, previous history of imprisonment, history of drug injection, history of tattooing, history of piercing, history of high-risk sex and family history of hepatitis C were extracted from patients’ records. To evaluate HCV status, blood samples were collected and tested.

In this study, 179 participants were included. Nine participants (5.0%, 95% CI, 2.3-9.3) were positive for hepatitis C. HCV infection was not significantly associated with age, marital status, education, previous history of imprisonment, length of imprisonment, piercing and high-risk sex; however, there was a significant association between a history of tattooing and a history of injecting drug use and Hepatitis C.

The prevalence of hepatitis C among male prisoners in Great Tehran Prison was 5% in this study, similar to recent studies on prisoners in Tehran. A history of drug injections as well as tattooing were the most important risk factors for hepatitis C in male prisoners.

The purpose of this paper is to consider the potential benefits and challenges of applying a strategy of “seek, test, treat and retain” (STTR) to hepatitis C virus (HCV) in the US criminal justice system.

The authors draw on the published literature to illustrate how each component of STTR could be applied to HCV in the US criminal justice system, and describe challenges to the implementation of this strategy.

The burden of morbidity and mortality associated with chronic HCV infection in the USA is increasing and without significantly increased treatment uptake, will likely continue to do so for several decades. The authors argue that the US criminal justice system is an ideal focus for HCV case finding and treatment due to a high prevalence of infection and large volume of individuals in contact with this system. STTR would identify large numbers of HCV infections, leading to opportunities for secondary prevention and primary care. Important challenges to the implementation of STTR include treatment costs and training of prison medical providers.

This paper highlights opportunities to address HCV in the US criminal justice system.

Correctional facilities host a disproportionately high prevalence of HBV, HCV and HIV infection. We evaluated the prevalence of HBV and/or HCV co‐infection among HIV‐infected inmates entering our correctional facility. Over a 30‐month period, 173 consecutive HIV‐infected inmates entered our institution and were evaluated. HCV co‐infection was observed in more than 90% of the tested HIV‐infected inmates, past HBV infection in 77.4% and active HBV co‐infection in 6.7%; triple coinfection (HIV, HCV and HBs‐Ag positivity) was seen in 6.1% of them. Given the observed high prevalence of co‐infection, testing for HBV and HCV in all HIV‐infected inmates at entry in any correctional system is recommended to identify those in need of specific care and/or preventing interventions.

Hepatitis C virus (HCV) infection is a major public health concern in Canada, which now mostly affects marginalized populations, including correctional inmates. These populations ‐ until recently ‐ have largely been excluded from HCV pharmacotherapy. We report preliminary data on HCV treatment in a federal correctional population sample in British Columbia (BC), using Pegetron combination therapy. HCV RNA results are presented at week 12 of treatment, a strong predictor of treatment outcome. Just over four‐fifths (80.8%) of inmate patients had no detectable HCV RNA at week 12; inmates with genotype 2 and 3 fared better than those with genotype 1. These preliminary results suggest that HCV treatment is feasible and promises to be efficacious in correctional populations.

The purpose of this paper is to examine the drug use and criminal justice factors related to hepatitis C virus (HCV) antibody reactivity among rural women in the USA recruited from local jails.

Analyses included 277 women with a history of injection drug use from three rural jails in Kentucky. Participants completed health and drug use questionnaires and received antibody testing for HCV.

The majority of women tested reactive to the HCV antibody (69 percent). Reactivity was associated with risk factors, such as unsterile needle use. Criminal justice variables, including an increased likelihood of prison incarceration, an earlier age of first arrest, and a longer incarceration history, were associated with HCV reactive tests. Participants also endorsed several barriers to seeking healthcare before entering jail that were more prevalent in women testing HCV reactive regardless of HCV status awareness before entering jail.

Injection and high-risk sharing practices as well as criminal justice factors were significantly associated with HCV reactivity. Future research and practice could focus on opportunities for linkages to HCV treatment during incarceration as well as during community re-entry to help overcome real or perceived treatment barriers. The current study highlights the importance of the criminal justice system as a non-traditional, real-world setting to examine drug use and related health consequences such as HCV by describing the association of high-risk drug use and criminal justice consequences with HCV among rural women recruited from local jails.

Injection drug use (IDU) and IDU‐related infectious diseases such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are highly prevalent among prisoners worldwide. However, little is known about the prevalence of IDUs, HCV/HIV and the availability of respective treatment options in German prisons. Data provided by prison physicians of 31 prisons, representing 14,537 inmates, were included in this analysis. The proportion of IDUs among all prisoners was 21.9%. Substitution treatment was available in three out of four prisons (74.2%). Overall, 1137 substitution treatments were provided annually with a wide range of treatment aims. The prevalence rate was 14.3% for HCV and 1.2% for HIV. Around 5.5% of all HCV‐infected prisoners were in antiviral treatment annually, 86.5% of all HIV‐positive inmates in antiretroviral HIV‐treatment. Generally, substitution treatment, and HCV and HIV testing and treatment are available. However, due to abstinence‐orientated treatment aims, substitution treatment is rarely available as maintenance treatment, and HCV/HIV‐treatment is mainly provided for patients with an existing treatment before imprisonment. The inconsistent data quality necessitates changes in prison‐related policy to improve surveillance and to generate aggregated data in German prisons. The selection process in this analysis might lead to overestimating the provision of substitution and antiviral HCV‐treatment.

Worldwide efforts to identify individuals infected with the hepatitis C virus (HCV) focus almost exclusively on community healthcare systems, thereby failing to reach high-risk populations and those with poor access to primary care. In the USA, community-based HCV testing policies and guidelines overlook correctional facilities, where HCV rates are believed to be as high as 40 percent. This is a missed opportunity: more than ten million Americans move through correctional facilities each year. Herein, the purpose of this paper is to examine HCV testing practices in the US correctional system, California and describe how universal opt-out HCV testing could expand early HCV detection, improve public health in correctional facilities and communities, and prove cost-effective over time.

A commentary on the value of standardizing screening programs across facilities by mandating all facilities (universal) to implement opt-out testing policies for all prisoners upon entry to the correctional facilities.

Current variability in facility-level testing programs results in inconsistent testing levels across correctional facilities, and therefore makes estimating the actual number of HCV-infected adults in the USA difficult. The authors argue that universal opt-out testing policies ensure earlier diagnosis of HCV among a population most affected by the disease and is more cost-effective than selective testing policies.

The commentary explores the current limitations of selective testing policies in correctional systems and provides recommendations and implications for public health and correctional organizations.

Hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. Approximately 30,000 prisoners are held in Australian prisons at any one time, with more than 30 per cent testing positive for HCV antibodies. Prisoners have been identified in the National Hepatitis C Strategy as a priority population for assessment and treatment. The purpose of this paper is to examine the rates of HCV testing and treatment, as well as barriers and opportunities for development of infrastructure for enhanced services.

Interviews were conducted with 55 stakeholders from the correctional sector in each state and territory in Australia in two stages: service directors to gather quantitative data regarding rates of testing and treatment; and other stakeholders for qualitative information regarding barriers and opportunities.

Of more than 50,000 individuals put in in custody in Australian prisons in 2013, approximately 8,000 individuals were HCV antibody positive, yet only 313 prisoners received antiviral treatment. The barriers identified to assessment and treatment at the prisoner-level included: fear of side effects and the stigma of being identified to custodial authorities as HCV infected and a likely injecting drug user. Prisoners who came forward may be considered unsuitable for treatment because of prevalent mental health problems and ongoing injecting drug use. Provision of specialist hepatitis nurses and consultants were the most frequently recommended approaches to how prison hepatitis services could be improved.

Many personal and systems-level barriers relevant to the delivery of HCV treatment services in the custodial setting were identified. Ready access to skilled nursing and medical staff as well as direct acting antiviral therapies will allow the prison-sector to make a major contribution to control of the growing burden of HCV disease.