Rapid HCV testing in jails: linkage to care barrier
Posted on April 1, 2015
Rapid HCV testing within jails identifies previously unrecognized cases of HCV infection, but linkage to care after release is a major barrier
One-third of all HCV-infected individuals in the USA pass through the criminal justice system each year, so at any given time the correctional population in the USA bears a heavy burden of HCV infection. HCV antibody prevalence among incarcerated adults in North America is estimated to be 29%, and the prevalence among incarcerated adults with a history of injection drug use is estimated to be much higher (approximately 67%).
Correctional facilities may be an ideal venue to offer rapid HCV testing, especially in those jails where individuals are often incarcerated for short periods of time (hours to days) prior to being released back to the community. The first study to investigate the use of rapid HCV testing inside a US correctional institution was conducted at the Rhode Island Department of Corrections (RIDOC) between August 2012 and January 2014, and was recently published in the March 2015 issue of the Journal of Public Health Advance. Individuals who were known to be HCV antibody positive based on medical record review were excluded from the study.
Participants completed a staff-administered computerized questionnaire and were shown an 8-min informational video that reviewed HCV transmission, rapid HCV testing procedures and a brief overview of HCV care and treatment. Participants were then offered the OraQuick HCV Rapid Antibody Test [OraSure Technologies, Bethlehem, PA, USA] using a blood specimen obtained from a fingerstick. Results were obtained in approximately 20 minutes and were delivered to the participant in conjunction with post-test counseling. Participants who had a positive confirmatory HCV RNA plasma viral load test were notified in person by research staff and were referred to the Miriam Hospital for HCV evaluation in the community after release.
Of 249 participants who completed all study activities, 25 (10%) had a reactive rapid HCV test, and were significantly more likely to be the following:
- White and less likely to be Black/African American, Hispanic or another race (P = 0.0107)
- Have ever injected drugs (P <0.0001)
- Have recently injected drugs (P <0.0001)
Among the 23 (92%) who completed confirmatory HCV RNA testing, 15 (65%) had detectable HCV RNA indicating chronic infection and 8 had negative RNA testing suggestive of resolved HCV infection. Confirmatory test results were delivered to participants prior to release. While 12 of the 15 participants with confirmed chronic infection agreed to being referred to a community healthcare provider for HCV evaluation, only 4 (33%) completed an initial evaluation in the community. This study indicates that rapid HCV testing within prison and jail facilities is possible and likely to identify previously unrecognized cases of HCV infection. However, optimal ways to link individuals with chronic HCV infection to community care after release are urgently needed.