Routine Opt out Hepatitis C Testing Upon Intake in the Philadelphia Jail System

ABSTRACT

Background: Hepatitis C (HCV) infection disproportionately affects those in United States' correctional institutions with seroprevalence rates from 17.4-23.1%. Jails have represented a particularly challenging setting for HCV testing and treatment given the short duration of stay and uncertainty of the timing of prisoners' release. Despite recommendations that all incarcerated persons undergo HCV testing, screening is not universally performed. In the Philadelphia jails, 1463 (7.5%) of the 19395 prisoners in 2018 were screened at sentencing. Method(s) On September 3, 2019 the Philadelphia jail partnered with Philadelphia FIGHT Community Health Centers to implement routine opt out HCV testing upon intake. Protocols for testing, result delivery and provider follow up were developed in a collaborative manner between the jail and FIGHT and subsequently adapted to ensure success in response to the COVID-19 pandemic. Herein, we report the findings of the first thirty-two months of routine opt out screening at intake. Result(s) Between September 3, 2019 and April 30, 2022, 27633 individuals entered the jail. 25206 (91.22%) individuals were tested for HCV antibody (ab) upon entry. 2639 (95.72%) of 2757 ab+ individuals had reflexive RNA confirmatory testing and 1892 (68.63%) were chronically infected. Of those, 950 (50.21%) were seen by a linkage coordinator from FIGHT while incarcerated, 1338 (70.72%) were seen by a jail-based HCV provider, and 619 individuals were prescribed HCV treatment. Of the treated persons, 304 (65.84%) were released from jail before completing HCV treatment, but all left jail with a full course of treatment;linkage to care to determine treatment response and ongoing medical care is in progress. Conclusion(s) Establishment of routine opt out HCV screening in a jail setting resulted in more than 90% of individuals entering the jail being screened for HCV and 32% of those with chronic infection initiating treatment. Short duration of incarceration, the need for rapid result delivery, increased linkage coordinator visits, and coordination of treatment between the jail and the community are challenges that must be addressed for successful program implementation in a jail setting. Collaboration between health care providers in the correctional system and community is necessary to coordinate HCV services in a high volume, high turnover urban jail.