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Learning Objectives for this Presentation:
By the end of the presentation participants will be able to recognize the importance of evaluating hepatitis C virus (HCV) screening criteria in correctional facilities.
Background:
A 1999 study in the Wisconsin adult correctional system determined that targeted HCV screening of incoming inmates based on self-identified risk indicators and prior laboratory findings would detect 91% of HCV infections by testing 29% of inmates. Accordingly, a targeted screening program was implemented in 2000 and is evaluated periodically.
Methods:
HCV screening data from 2004 were compared with the 1999 study data, using chi-square tests to assess differences in proportions. A blinded serosurvey of a random sample of 500 unscreened inmates was conducted to estimate the HCV seroprevalence among inmates not meeting criteria in 2004.
Results:
Of 8,085 inmates admitted in 2004, 21% met predetermined risk criteria and therefore were screened for HCV, compared with 29% as predicted by the 1999 study (p<0.001). Risk indicators documented less often in 2004 than in 1999 included self-reported injection drug use, liver disease, hepatitis B virus core antibody positivity, receipt of blood or blood products, and dialysis. The only unchanged indicator was elevated alanine aminotransferase. HCV seropositivity among inmates meeting criteria in 2004 was 33%, compared with 41% in 1999 (p=0.004). HCV seropositivity among the 500 sampled inmates not meeting criteria was 4.8% compared with 1.7% in 1999 (p<0.001). Thus, the proportion of HCV infections detected in 2004 through targeted screening was estimated at only 65% compared with the expected 91% (p<0.001).
Conclusions:
The targeted HCV screening of inmates admitted in 2004 to the Wisconsin adult correctional system detected fewer infections than predicted by the 1999 criteria derivation study. This may be attributed to inadequate ascertainment of risk, primarily self-reported history of injection drug use and liver disease. Modifications of the existing criteria and the risk ascertainment process are under consideration.
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See more of The 2005 National Viral Hepatitis Prevention Conference