Every day thousands of Americans with treatable physical or mental health problems are locked up in jails and other secure facilities. Work by Theodore Hammett and others makes clear that a surprisingly large fraction of Americans living with HIV, tuberculosis, and a variety of psychiatric disorders pass through the correctional system every year. All too often, men and women with these disorders pass through criminal justice facilities relatively quickly, their illnesses undetected and thus unaddressed.
Hepatitis C is a particularly prevalent and serious condition, which infects a huge fraction of injection drug users. In an important JAMA commentary this week (in print, but apparently not yet posted on the web), Anne Spaulding and David Thomas note that between 29 and 43 percent of all Americans infected with this disease are estimated to pass through the criminal justice system every year. Hundreds of thousands of inmates have no idea that they are infected. That’s just a huge missed opportunity.
Rapid testing technologies can now provide good results within about 20 minutes. Opt-out HCV testing in correctional settings could easily identify hundreds of thousands of people who could then receive timely medical interventions. Given the increasingly effective array of new treatments, this could make a huge difference.
As we learned in the case of HIV, one must reach patients where they are. Injection drug users and others at-risk for this disease won’t always come to us. That means getting into our jails, detention centers, and substance abuse treatment facilities and making them work for public health. Physician-public health experts, such as my friend and co-auther Frederick Altice of Yale University, have been doing this for years, with good results. In many places, this is long overdue.