A Framework for Management of Hepatitis C in Prisons

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ANNALS OF INTERNAL MEDICINE

MEDICINE AND PUBLIC ISSUES

A Framework for Management of Hepatitis C in Prisons

Anne C. Spaulding, MD, MPH; M. Weinbaum, MD, MPH; Daryl T.-Y. Lau, MD,

MPH; Sterling, MD; Leonard B. Seeff, MD; Harold S. Margolis, MD; and

Jay H. Hoofnagle, MD

16 May 2006 | Volume 144 Issue 10 | Pages 762-769

The prevalence of chronic hepatitis C virus (HCV) infection in prisons

ranges from 12% to 31%. There are generally accepted—albeit still

evolving—guidelines for identification and treatment of hepatitis C in the

community. However, there is less agreement among health professionals

caring for prisoners about best practices for identification, medical

management, and treatment of hepatitis C. Inmates often lack health care

before incarceration. In prisons, infected persons could be identified and

the management of infection initiated; however, the high prevalence of HCV

infection among prisoners would impose a disproportionate cost for hepatitis

C care on the correctional system. The optimal solution is for prison and

public health systems in the United States to jointly provide targeted HCV

testing and standard-of-care hepatitis C medical management, treatment, and

prevention programs to prison inmate populations. The authors report on a

January 2003 meeting of experts in prison health, public health, hepatology,

and infectious diseases and explore the clinical care, prevention, and

collaboration needed to provide hepatitis C management in prisoners.

Author and Article Information

From Centers for Disease Control and Prevention, Atlanta, Georgia;

University of Texas Medical Branch, Galveston, Texas; Virginia Commonwealth

University Health System, Richmond, Virginia; and National Institutes of

Health, Bethesda, land.

Acknowledgments: The authors thank the following people for providing the

planning group with the correctional professional viewpoint: Gondles,

American Correctional Association; on, National Commission on

Correctional Health Care; , American Jail Association; and

Stalder, Association of State Correctional Administrators. The

authors also thank Bordelon, Centers for Disease Control and

Prevention, and McCready and Carol Schagunn, University of

Minnesota, for contributions to the coordination and planning of the January

2003 meeting in San , Texas.

Potential Financial Conflicts of Interest: Consultancies: D.T.-Y. Lau

(Roche, GlaxoKline, Bristol-Myers Squibb); Expert testimony: A.C.

Spaulding (Dr. Spaulding has given expert testimony on prisoners' right to

receive medical management of hepatitis C); Honoraria: D.T.-Y. Lau

(Bristol-Myers Squibb, Roche, GlaxoKline); Grants received: D.T.-Y. Lau

(GlaxoKline, Bristol-Myers Squibb, Roche), R. Sterling

(Schering-Plough, Roche); Grants pending: R. Sterling (Roche,

Schering-Plough).

Requests for Single Reprints: Anne C. Spaulding, MD, MPH, Rollins School of

Public Health of Emory University, Department of Epidemiology, 1518 Clifton

Road NE, Atlanta, GA 30322; e-mail, aspauld@....

Current Author Addresses: Dr. Spaulding: Rollins School of Public Health of

Emory University, Department of Epidemiology, 1518 Clifton Road NE, Atlanta,

GA 30322.

Dr. Weinbaum: Centers for Disease Control and Prevention, 1500 Clifton Road

MS G37, Atlanta, GA 30333.

Dr. Lau: University of Texas Medical Branch, 301 University Boulevard,

Galveston, TX 77555.

Dr. Sterling: Virginia Commonwealth University Health System, 1200 East

Broad Street, Room 1454, Richmond, VA 23298.

Drs. Seeff and Hoofnagle: National Institutes of Health, 31 Center Drive,

Bethesda, MD 20892.

Dr. Margolis: International Vaccine Institute, SNU Research Park, San 4-8

Bongeheon-7-dong, Seoul, Korea 151-818.

http://www.annals.org/cgi/content/abstract/144/10/762

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