Screening for Hepatitis C In Two North Carolina County Jails

Background: It is estimated that HCV is at least eight times more prevalent in the correctional population than in the general population.  The Communicable Disease Branch Expanded HIV Testing Program supports local health department and community-based organization screening for HIV and syphilis in 27 county jails.

Objectives: To determine the feasibility of integrating HCV with HIV and syphilis screening in North Carolina county jails.

Methods:  Two county health departments began integrating HCV into their Expanded Testing Program in jails in 2008.  Specimens were processed at a private reference laboratory.  Only acute HCV is reportable to the NC Communicable Disease Branch, so reactive HCV screening tests were self-reported by the health departments.  

Results:  Between 2008 and 2010, 1,553 detainees were screened for HIV, syphilis, and HCV in two county jails.  Seven (0.45%) tested positive for HIV, 10 (0.64%) tested reactive for syphilis, and 108 (6.95%) tested positive for HCV. Positivity rates for HCV were nearly equal for men and women (6.8% male; 6.9% female) but white non-Hispanics had a positivity rate twice the rate for black non-Hispanic men and women.  Nearly 80% of HCV positives were over 40 years of age.  Only two HIV-positive detainees were co-infected with HCV and one with syphilis. 

Conclusions:  Integrating HCV testing into a jail HIV and syphilis screening program is very productive for identifying HCV positive detainees.   However, the cost of private lab services and the ability to pay for additional testing to confirm active infection and determine treatment needs can be barriers to supporting HCV testing by a local health department.

Implications for Programs, Policy, and Research: Support for more expanded and integrated testing services in high risk populations can help identify cases of HCV and potentially result in behavior change for those testing positive.