Impact of new therapeutics for hepatitis C virus infection in incarcerated populations

Abstract

Inmate populations bear a disproportionate share of the burden of hepatitis C virus (HCV) infection. With more than 90% of prisoners released back to their communities within a few years of sentencing, incarceration can be viewed as an opportunity to provide HCV screening and therapeutic interventions to benefit the individual, reduce the costs of HCV management to the health care system from a societal perspective, and improve overall public health. Although optimal medical management of HCV within prison settings would increase the current cost of correctional health care, it could decrease transmission within the community, reduce overall disease burden, and lower the future societal health care costs associated with end-stage liver disease. Nonetheless, most prison systems treat only a small fraction of infected inmates. Current and emerging therapeutic agents will cure HCV infection in the vast majority of patients. Mathematical modeling also shows that expanded HCV screening and treatment are cost-effective from the societal perspective. In this article, we will describe appropriate treatment regimens, propose strategies to lessen the burden of these costly HCV therapies on correctional health care systems, and address the challenges of expanded HCV screening in correctional settings.

Figure.

Impact of length of hepatitis C virus (HCV) treatment and remaining duration of incarceration in prison populations, including prisoners with HCV. The duration of incarceration varies by individual. The frequency of various lengths of stay follows a negative exponential distribution. Many persons have short times remaining before prison release. A few have a very long remaining time to serve. (top) Currently, with a year-long peginterferon alfa plus ribavirin (PEG-IFN/RBV) regimen, only a few prisoners with HCV have sufficient time before release to complete therapy—these are represented by the tail end of the distribution of remaining time to be served. (bottom) Shortening the time to complete HCV treatment by using a novel regimen means that there would be an exponentially greater number of prisoners with HCV who could complete therapy before release.