Wisconsin Department of Health Services

Hepatitis C Testing in Wisconsin Prisons

Lauren Stockman, MPH Hepatitis C Epidemiologist NASTAD Hepatitis Technical Assistance Meeting Washington, DC October 21, 2015

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Wisconsin Department of Health Services

Hepatitis C in United States Prisons • In U.S. prisons, hepatitis C virus (HCV) is: o Up to 20 times more prevalent than in general population. o Associated with rising death rates after incarceration.

• In U.S. prisons, liver disease is: o The third-ranking cause of death. o Surpassed by heart disease and cancer.

Weinbaum C, et al. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2003 Jan 24;52(RR-1):1-36. Ditah et al. Hepatology. 2014 Apr;60(4):691-8. Noonan. Bureau of Justice Statistics, Washington, DC; 2014. Available at: http://www.bjs.gov/content/pub/pdf/mljsp0012st.pdf Spaulding AC, et al. American Journal of Public Health. 2015 May;105(5):e51-7. 2

Wisconsin Department of Health Services

HCV in United States Prisons • One third of people living with HCV are estimated to have passed through U.S. corrections. • Corrections is an opportunity to identify infection. • Few facilities conduct routine HCV testing: 11 out of 50 state prisons reported routine HCV testing in 2015.

Hammett TM, e al. Am J Public Health. 2002 Nov;92(11):1789-94. Beckwith CG, et al. Am J Public Health. 2015 Jan;105(1):68-71. 3

Wisconsin Department of Health Services

Wisconsin HCV Testing Strategy For the past decade, the Wisconsin Department of Corrections (DOC) has conducted targeted HCV screening using: • • • •

Medical history Clinical exam Self-reported risk factors Inmate request

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Wisconsin Department of Health Services

Wisconsin HCV Testing Strategy • Results from targeted screening in place up to 2014 o Incoming inmates tested: 30% o Antibody positive rate: 16% o Reflexive PCR testing on all antibody positives: 60% RNA positive • Treatment o Based on sentence length and clinical indicators.

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Wisconsin Department of Health Services

Hepatitis C Reports from Wisconsin Department of Corrections Reported Hepatitis C Virus Infections, Department of Corrections 10%

Percent of Statewide Reports

Number of HCV Cases

7%

8%

8%

202

209

2011

2012

6%

158

158

2009

2010

256

2013

10%

313

2014

Year of Test

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Wisconsin Department of Health Services

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Hepatitis C Reports from Wisconsin Department of Corrections Age Distribution in 2009

Number

20

N=158, median age 43 years

15 10 5 0 15

21

26

31

36

25

46

51

56

61

66

Age Distribution in 2014

20 Number

41

N=313, median age 32 years

15 10 5 0 15

21

26

31

36

41 46 Age (Years)

51

56

61

66

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Wisconsin Department of Health Services

Hepatitis C Reports from Wisconsin Department of Corrections Sex 14% Female

Race and Ethnicity 20% Female

78%

White Black or African American Hispanic American Indian

10% 7% 3% Year 2009

Year 2014

Year 2014 2% with unknown race not shown

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Wisconsin Department of Health Services

HCV in Wisconsin Prisons • Trends of people incarcerated with HCV match trends in community. • Dramatic rise in young adults, statewide, match HCV trends at intake to prison.

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Wisconsin Department of Health Services

Collaboration and Partnerships • Quarterly meetings among: o o o o

Wisconsin Department of Corrections Wisconsin Division of Public Heath Wisconsin State Laboratory of Hygiene University of Wisconsin-Madison School of Medicine and Public Health  Research, evaluation  Clinical providers, infectious disease specialists

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Wisconsin Department of Health Services

Collaboration and Partnerships • Find out the prevalence of HCV at intake to DOC • Evaluate screening practices. o How many HCV infections are captured by the selective screening currently in place? o Is there added value of CDC-recommended birth-cohort screening?

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Wisconsin Department of Health Services

Evaluation: Methods • Added universal HCV testing to health intake procedures at DOC prison facilities. o Time period November 3, 2014 – January 31, 2015 o Two facilities conduct all adult intake exams

• Analyzed data from routine intake exam for association with HCV infection. • Calculated the proportion with a risk factor among all detections.

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Wisconsin Department of Health Services

Evaluation: Results • 1,250 Individuals were admitted to adult prison facilities and 1,239 (99%) were tested for HCV • 155 (12%) were anti-HCV positive at intake • 110 of 155 (71%) were HCV PCR positive • Difference between male and female facility: o Male anti-HCV positive: 11% o Females anti-HCV positive: 21%

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Wisconsin Department of Health Services

Evaluation: Results Prevalence of HCV infection, by birth cohort. 30 HCV Ab+ Prevalence

25

Male Female

20

25%

22%

21%

22%

15

13%

10 5

9%

0 1985 and later (under 30)

1966-1984 (30-48) Birth Cohort (Age)

1945-1965 (49-69)

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Wisconsin Department of Health Services

Evaluation: Results

Percent

Percent of all inmates reporting history of injection drug use at intake, by sex and birth cohort. 50 45 40 35 30 25 20 15 10 5 0

Male Female

45% 31%

14% 1985 and later (