Experts discuss hepatitis C epidemic in U.S. state prisons

The World Health Organization aims to eliminate hepatitis C as a public health threat by 2030. The blood-borne virus affects more than 2 million people in the United States and killed more than 15,700 people nationwide in 2018, although more than 95 percent of people infected with hepatitis C can be cured if they take medications to treat the disease.

But a large number of U.S. state prisons are failing to adequately address the treatable disease, as approximately 55% of those infected in U.S. state prisons remain untreated, according to a new Emory University-led study published in 2017. Journal of Infectious Diseases.

We asked the study’s lead author Anne Spaulding, MD, associate professor of epidemiology and global health at Emory University’s Rollins School of Public Health, to answer five questions and explain why these findings matter to prison populations and society at large.

Why is this research important to the public?

Without treating hepatitis C among incarcerated populations, we will not achieve our goal of eliminating hepatitis C by 2030. The United States has the highest incarceration rate in the world, and the prevalence of hepatitis C in prisons is approximately 10 times higher than in the general population.

A driver of the hepatitis C epidemic is injection drug use, especially when people share needles. This is how the virus spreads from one person to another. To eliminate a treatable infectious disease, you need to know where the hot spots are. Prisons are hotspots for hepatitis C. Our article reveals the hottest of the hotspots.

The opioid epidemic has not affected all states equally, and states’ legal systems respond differently to drug use. Some states send many people who inject heroin and other drugs to prison, while others send them to rehab.

Why are incarcerated populations a meaningful group to study?

Incarcerated populations have the highest rates of hepatitis C infection and are lagging behind in access to care. In this study, we demonstrate that the virus is active in 55% of those infected in state prisons. Everyone in prison deserves access to medical care—willful indifference to the health needs of those behind bars violates the Eighth Amendment to the U.S. Constitution.

Did anything about the results of this study surprise you?

This article examines viral exposure and infection persistence and shows that heterogeneity in the epidemic persists. Our previous hepatitis C research showed that the proportion of prison populations who have antibodies varies by state.

The new study adds details about measuring virus levels in the blood. We now report these blood-measured rates of active infection (viremia) by state. This more detailed information magnifies differences between states beyond just antibody prevalence (markers of past/current infection combined).

Where is access to treatment most lacking?

Which segment of the legal criminal population is under-treated – it’s easy. Prisons, short-term stays for people awaiting trial. Most of the people in prison today have been in prison before; most of the people in prison will not be in prison. Nearly 10 million Americans are imprisoned each year, many with untreated hepatitis C.

Which prison system has the most people without treatment, and which prison system has a harder time getting infected people to get treatment? These questions are difficult to answer without better data, and our research shows that state prisons vary widely in their understanding of the pandemic.

Some states, like Mississippi, can’t tell you how many people have been exposed to the virus. Other countries, like California, can tell you how many people have been exposed to the virus, how many were infected upon entry and how many still need treatment.

What did you learn from this research that might help solve this problem?

A measure of disease prevalence—a dashboard, as it were—provides direction on where health care planners need to direct their efforts. This is helpful for COVID-19; we need similar drugs for hepatitis C in the incarcerated population. Prison health services can systematically treat hepatitis C at a population level. Treatment is expensive, but prices are falling, so curing hepatitis C in prisons is feasible.