Screening for hepatitis C in jail

Hundreds of thousands of people could be helped through opt-out hepatitis C testing in correctional settings.

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.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

One thought on “Screening for hepatitis C in jail”

  1. Good point Harold. On the same topic, correctional environments are also a place to offer Hepatitis B vaccines.

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