Universal opt-out screening for hepatitis C virus (HCV) within correctional facilities is an effective intervention to improve public health

• Date: 11 September 2017
• Pages: 192-199
• Published date: 11 September 2017
• DOI: https://doi.org/10.1108/IJPH-07-2016-0028
• Author: Meghan D. Morris,Brandon Brown,Scott A. Allen
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Universal opt-out screening for hepatitis

C virus (HCV ) within correctional

facilities is an effective intervention to

improve public health

Meghan D. Morris, Brandon Brown and Scott A. Allen

Abstract

Purpose –Worldwide efforts to identify individuals infected with the hepatitis C virus (HCV) focus almost

exclusively on community healthcare systems, thereby failing to reach high-risk populations and those with

poor access to primary care. In the USA, community-based HCV testing policies and guidelines overlook

correctional facilities, where HCV rates are believed to be as high as 40 percent. This is a missed opportunity:

more than ten million Americans move through correctional facilities each year. Herein, the purpose of this

paper is to examine HCV testing practices in the US correctional system, California and describe how

universal opt-out HCV testing could expand early HCV detection, improve public health in correctional

facilities and communities, and prove cost-effective over time.

Design/methodology/approach –A commentary on the value of standardizing screening programs across

facilities by mandating all facilities (universal) to implement opt-out testing policies for all prisoners upon entry

to the correctional facilities.

Findings –Current variability in facility-level te sting programs result s in inconsistent testi ng levels

across correctional facilities, and therefore makes estimating the actual number of HCV-infected

adults in the USA difficult. The authors argue that universal opt-out testing policies ensure earlier

diagnosis of HCV among a population most affected by the disease and is more cost-effective than

selective testing policies.

Originality/value –The commentaryexplores the currentlimitations of selective testingpolicies in correctional

systems and provides recommendationsand implications for public healthand correctional organizations.

Keywords Criminal justice system, Public health, California, Epidemiology, HCV testing, Hepatitis C virus (HCV)

Paper type Viewpoint

Scope of the problem

Hepatitis C virus (HCV) infection is a global health issue of urgent importance. An estimated 170

million individuals are currently infected with HCV worldwide and result in 350,000-500,000

deaths a year. Globally, three to four million people are newly infected each year (Global Burden

Of Hepatitis C Working Group, 2004; Mohd Hanafiah et al., 2013). In middle- and high-income

countries where the blood supply is screened, HCV is most often transmitted through

contaminated needles and/or injection equipment. The prevalence of HCV is higher

in correctional populations compared with the general population, with prevalence within

correctional populations highest in Asia (40 percent), Australia (35 percent), and the USA

(40 percent) (Larney et al., 2013; Varan et al., 2014). In the USA, HCV is the most common

blood-borne viral infection with an estimated 2.5-3.2 million people in the general population

infected with the chronic HCV (Beasley and Alter, 2010). And with more than ten million

Americans move in and out of correctional facilities per year the correctional system offers

an efficient, but often missed, opportunity for identification of people infected with HCV.

Received 23 September 2016

Revised 11 December 2016

15 March 2017

Accepted 28 April 2017

© Meghan D. Morris, Brandon

Brown and Scott A. Allen.

Published by Emerald Publishing

Limited. This article is published

under the Creative Commons

Attribution (CC BY 4.0) licence.

Anyone may reproduce, distribute,

translate and create derivative

works of this article (for both

commercial and non-commercial

purposes), subject to full attribution

to the original publication and

authors. The full terms of this

licence may be seen at http://

creativecommons.org/licences/by/

4.0/legalcode

This work was supported by a

pilot award from the UC Criminal

Justice AND Health Consortium

through a grant from the UC Office

of the President, M.D. Morris, is

supported through a NIH/NIDA

Career Development Award

(K01DA037802).

Meghan D. Morris is an Assistant

Professor of Epidemiology at the

Department of Epidemiology &

Biostatistics, University of

California, San Francisco,

San Francisco, California, USA.

Brandon Brown is an Assistant

Professor at the Center for

Health Communities, University

of California, Riverside,

Riverside, California, USA.

Scott A. Allen is a Professor

and the Clinical Director at the

School of Medicine, University

of California, Riverside,

Riverside, California, USA.

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VOL. 13 NO. 3/4 2017, pp. 192-199, Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-07-2016-0028