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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 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.

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.

Prison populations in Western countries are characterised by a high hepatitis C prevalence. This reflects a high rate of imprisonment for drug related offences. Prison entrants who are HCV‐negative face a significant risk of acquiring hepatitis C. Effective prevention strategies and successful treatment of a significant percentage of hepatitis C‐positive inmates could reduce the risk of transmission in the prison context significantly. Several reports of treating hepatitis C in prisoners in major facilities have been published. We report our experience of establishing a liver clinic service in two regional prisons in New South Wales, Australia. Liver biopsy requirements to access treatment in Australia meant that only 46 of 196 reviewed patients were able to commence treatment in our 5‐year experience. Treatment completion rate was 61% and end of treatment viral response was 57%. The removal of liver biopsy requirements in Australia in April 2006 has freed up access to treatment and our results encourage further effort to optimise the process of assessment and treatment in this high‐risk population.

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.

The purpose of this paper is to develop and validate the first instrument to measure the source of customers’ stigmatization of employees with hepatitis C virus (HCV) in Egypt.

The development and validation processes unfolded as follows: an item pool was generated from focus groups and previous studies on stigma; the initial instrument was evaluated by three experts and pilot-tested; the instrument was used to collect data from 500 Egyptian consumers to determine its dimensionality; to test this structure, confirmatory factor analysis was conducted on a new sample of 300 Egyptian consumers.

Exploratory factor analysis showed that the instrument captures three factors: devaluation, avoidance and pity. Results confirmed that customers’ stigmatization of employees with HCV is a multidimensional construct that is manifested in these three dimensions.

Despite the importance of disease stigma, management scholars have not given it sufficient attention. This paper offers new insights into the study of a particular type of workplace discrimination and ways of measuring it.

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.

Prison populations are considered at elevated risk of blood borne virus (BBV) transmission. Between December 2015 and February 2016, four new cases of HIV infection were diagnosed across two male vulnerable prisoner (VP) custodial units in Wales, UK. Cases were identified through routine BBV testing. The paper aims to discuss these issues.

As a result of identifying four new HIV cases, targeted BBV testing across the VP units using dried blood spot testing for HIV, Hepatitis C (HCV) and Hepatitis B was undertaken.

A total of 617 men were offered testing, 256 (41 per cent) were tested. No further cases of HIV were identified. Eight men were identified as HCV antibody positive. There was no evidence to suggest the four original cases of HIV were linked.

Embedding universal BBV screening within prison health provision will ensure timely identification of cases. Further research is needed to better understand BBV transmission risks within subsets of the prison population such as the VP and sex offending groups.

Little is known about the prevalence of BBVs in vulnerable prison populations. The findings add to the knowledge available for practitioners in the field.

At least 20% of individuals living with HIV pass through prison and jail doors every year, in any nation, worldwide. Therefore, interventions that improve access to HIV testing, HIV care, and education can have a broad impact on public health in every country. The benefits of these interventions in correctional settings have already been well documented. For example, improved access to HIV testing, treatment by an HIV specialist, preventive vaccinations and prophylactic medications, screening for concomitant infections such as HCV, and pre‐release planning services have been shown to decrease HIV‐related mortality and morbidity, to reduce the risk of HIV transmission and to decrease recidivism. Education of at‐risk individuals has also been shown to reduce HIV risk behaviors. Safe distribution of condoms and needle‐exchange programs have also been demonstrated to be safe and effective, although few such programs have been implemented in the United States. While all the available evidence has demonstrated that these public health‐oriented interventions can be and are successful in correctional settings, implementation on a national and international level lags far behind the evidence. The time has come to take an evidence‐based approach to improving HIV management in correctional settings. Implementations of the HIV management interventions described in this article make good medical sense and will have a positive impact on the health of inmates and the communities to which inmates return.

The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender.

CHC and its treatment options were reviewed examining their relationship with depression and gender.

CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results.

The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach.