Hepatitis C Epidemiology in a Large Urban Jail: A Changing Demographic

Abstract

Objectives: Nearly 1 in 3 people with hepatitis C virus (HCV) infection pass through the criminal justice system annually; the system is a crucial location for HCV screening, education, and linkage to care. We aimed to (1) determine the prevalence and incidence of HCV antibody positivity and (2) evaluate the demographic characteristics of people with HCV in a large urban jail.

Methods: We offered universal opt-out HCV testing to any person undergoing a routine blood test at the Dallas County Jail from June 2015 through December 2019 (N = 14 490). We extracted data on demographic characteristics from the electronic medical record and collected data on risk factors from people with HCV antibody positivity. We performed univariate and multivariate analyses.

Results: The prevalence of HCV antibody positivity was 16.7%; the incidence was 13.5 cases per 1000 person-years. HCV antibody positivity was significantly associated with older age (P < .001), female sex (P = .004), non-Hispanic White race versus non-Hispanic Black race (P < .001), and being released to prison versus not (P < .001). Among people born after 1965, those who were HCV antibody-positive were more frequently non-Hispanic White and Hispanic women, whereas among those born in 1965 or before, those who were HCV antibody-positive were more frequently non-Hispanic Black men.

Conclusions: The high prevalence and incidence of HCV antibody positivity in a large county jail argue for routine, universal HCV testing and prevention counseling in criminal justice settings. Changing demographic characteristics mirror those of the national injection drug use epidemic and shed insight into designing interventions for risk reduction, education, linkage to care, and treatment.

Keywords: hepatitis C; incarceration; jail.

Figure 1.

Hepatitis C virus (HCV) antibody and HCV RNA positivity among people screened for HCV in the Dallas County Jail from 2015 to 2019 (N = 14 490). From 2017 to 2019, reflex HCV RNA testing was incorporated into HCV testing. Data were collected by the authors from electronic medical records and release records.

Figure 2.

Hepatitis C virus (HCV) antibody prevalence and number of people tested for HCV by birth year among people (n = 10 183) at the Dallas County Jail screened from 2017 to 2019. Data were collected by the authors from electronic medical records and release records.

Figure 3.

Demographic epidemiological trends in hepatitis C antibody prevalence by year of birth among people at the Dallas County Jail screened from 2017 to 2019 (n = 10 183). Prevalence ratios per birth year were calculated by dividing the prevalence in each demographic group by the prevalence in the general jail population in that year. Dots indicate prevalence ratio in each year; dashed line indicates trend line. Data were collected by the authors from electronic medical records and release records.