Screening and Treatment for HCV in Correctional Settings

This project explores effective and feasible screening and treatment strategies for HCV in correctional settings.

There is a high prevalence of HCV in jails and prisons in the United States, but the limited availability and high cost of effective HCV treatments creates a dilemma for departments of corrections. Correctional facilities are constitutionally mandated to provide the “community standard” of medical care to all offenders, but the cost of treating all HCV-infected patients in a given corrections system could exceed the entire healthcare budget for the system (Spaulding et al. 2013). This double liability has resulted in no clear direction for HCV screening and treatment guidelines. Despite the high prevalence of HCV and a potentially ideal platform for identifying and treating those infected with HCV, at this time, correctional systems offer little HCV care.

We are using an existing Monte-Carlo simulation to compare four HCV screening and three HCV treatment strategies in incarcerated populations, in terms of clinical outcomes, budget impacts, and cost-effectiveness of these interventions.

Our major research questions include:

  • What are the expected clinical outcomes, costs, and cost-effectiveness of various approaches to screening for HCV in correctional systems including: a) no screening, b) screening those who report a history of injection drug use or are being incarcerated for a drug-related crime (targeted screening); c) screening those born 1945-1964 (birth cohort screening); and d) routine, opt-out screening for all offenders without attempt to identify specific risk factors (universal screening)? We will stratify each of the above screening strategies by correctional setting (prison vs. jail), as the epidemiology of HCV likely differs in each location.
  • What are the anticipated clinical outcomes, costs, cost-effectiveness, and budget impact of strategies for prioritizing prison patients for HCV treatment? We will consider 2 dimensions for prioritization including: a) duration of remaining sentence, and b) degree of fibrosis; and we will also consider cost/efficacy tradeoffs between competing interferon-free regimens.
  • In the jail setting, what are the clinical outcomes and costs associated with treating inmates while they are in jail, compared to identifying cases in jail and then linking to care upon release?

Reference:

  1. Spaulding AS, Kim AY, Harzke AJ, Sullivan JC, Linas BP, Brewer A, et al. Impact of new therapeutics for hepatitis C virus infection in incarcerated populations. Topics in antiviral medicine. 2013;21(1):27-35. Epub 2013/04/19. PubMed PMID: 23596276; PubMed Central PMCID: PMC3875217.