HCV:
The Correctional Conundrum
(continued)
Rationale for Screening
Approximately 50% of persons
with hepatitis are unaware of their hepatitis infection.22 Testing for
infection informs the patient and physician about the potential for and
possible existence of liver damage. It should serve as an important prompt
for a discussion about risky behaviors and transmission to others.23 The
CDC lists correctional institutions, HIV counseling and testing sites,
and drug and STD treatment programs as sites where hepatitis screening
and interventions should take place. (See Table 2 for recommendations.)
Reducing the cost of
screening
If the cost of screening
an incarcerated population for HCV appears to be prohibitive, targeted
screening can reduce the cost of screening and still identify most HCV
at-risk individuals. For example, in a Wisconsin study of HCV screening
in a local prison, 60.5% of HCV infections were identified by screening
those who had history of IDU. By including any individuals who also had
an ALT > 51, the facility identified 79.6% of HCV infections. Adding a
history of liver disease to the criteria for testing allowed the identification
of 83.6% of HCV-infected individuals. When individuals who were HBV+ were
also screened, the correctional facility identified 90.8% of the HCV infections.
The cost of testing was reduced by two thirds (compared to mass screening)
using their criteria, and was very effective.25
CONTINUE...
|
|
|
