Epidemiology of hepatitis C virus in Pennsylvania state prisons, 2004-2012: limitations of 1945-1965 birth cohort screening in correctional settings.
OBJECTIVE
We described hepatitis C virus antibody (anti-HCV) prevalence in a state prison system and retrospectively evaluated the case-finding performance of targeted testing of the 1945 to 1965 birth cohort in this population.


METHODS
We used observational data from universal testing of Pennsylvania state prison entrants (June 2004-December 2012) to determine anti-HCV prevalence by birth cohort. We compared anti-HCV prevalence and the burden of anti-HCV in the 1945 to 1965 birth cohort with that in all other birth years.


RESULTS
Anti-HCV prevalence among 101,727 adults entering prison was 18.1%. Prevalence was highest among those born from 1945 to 1965, but most anti-HCV cases were in people born after 1965. Targeted testing of the 1945 to 1965 birth cohort would have identified a decreasing proportion of cases with time.


CONCLUSIONS
HCV is endemic in correctional populations. Targeted testing of the 1945 to 1965 birth cohort would produce a high yield of positive test results but would identify only a minority of cases. We recommend universal anti-HCV screening in correctional settings to allow for maximum case identification, secondary prevention, and treatment of affected prisoners.
Sarah Larney is with Alpert Medical School, Brown University, Providence, RI, and National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia. Madeline K. Mahowald is with the Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, and Alpert Medical School, Brown University. Nicholas Scharff is with the Pennsylvania Department of Corrections, Mechanicsburg. Timothy P. Flanigan, Curt G. Beckwith, and Nickolas D. Zaller are with the Division of Infectious Diseases, The Miriam Hospital, and Alpert Medical School, Brown University.
Sarah
S
Larney
Madeline K
MK
Mahowald
Nicholas
N
Scharff
Timothy P
TP
Flanigan
Curt G
CG
Beckwith
Nickolas D
ND
Zaller
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data; D011330:Prisons / Q000706:statistics & numerical data*; D012737:Sex Factors; D055815:Young Adult