Hepatitis C among prisoners is too common. And despite recent efforts to increase access to curative treatments, up to one-third of hepatitis C positive prisoners still go untreated. This comes at a price: unnecessary disease progression for patients and increased risk of spread to others.
Addressing hepatitis C within incarcerated populations is going to depend on strengthening three pillars:
- Screening. Quick and efficient on-site testing upon entry is necessary whether the inmate has a shorter stay in jail or a longer sentence in prison. This can be done by partnering with a state or local health department or a private health center. Regardless of who is doing the screening, getting it done requires resources, which many administrations are loath to dedicate.
- Linkage to care. Many state corrections departments have longer-term plan of care processes for inmates since sentences are longer – from a year to life. In contrast, most municipal facilities tend to address only urgent health care needs. However, length of stay shouldn’t be an excuse for not linking patients to necessary care.
- Treatment initiation. Through a “Netflix-style” subscription model, Louisiana and Washington states contracted for an unlimited supply of direct acting antiviral treatment for certain populations, including prisoners. Other states are also considering a similar model, but paying to have curative medication available is only worthwhile if effective systems for screening and linkages to care are in place.
There is not one correct approach for addressing these challenges. Rather policymakers, health care providers, law enforcement and corrections administrators, and advocates should collaborate to develop tailored solutions for each environment. This also includes working with people after their release. Parole officers, for example, can be trained to follow up about treatment adherence during their usual visits with parolees. Creative solutions like this one will help the nation achieve elimination.
Elimination by 2030
While it might be a stretch given current disease trends, I think the goal of eliminating hepatitis C by 2030 is still possible. In addition to strengthening the three pillars above, advocates must also work to:
- Remove barriers to care. Requiring patients to meet sobriety requirements or wait until their disease has progressed to an advanced stage before being eligible for medication is both risky and unnecessary.
- Broaden the base of prescribers. Specialists aren’t the only ones with the ability to understand how to treat hepatitis C; primary care providers can do it, too. Letting more providers prescribe curative medication will help more patients get treated.
Tackling the burden of hepatitis C among incarcerated populations is a big challenge. But it’s also achievable if we bolster our approach, work together and get creative.