In a retrospective cohort study, researchers from Albert Einstein College of Medicine in New York found hepatitis C virus infection to be common among formerly incarcerated individuals seen at the Bronx transitions clinic. Despite being so common, few patients were actually treated and cured.
“Following release from incarceration, there are opportunities to engage HCV-infected individuals in medical care and initiate HCV treatment; however, barriers such as lack of insurance coverage or provider availability prevent individuals with criminal justice involvement from accessing medical care,” Aaron D. Fox, MD, MS, assistant professor of medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, and colleagues wrote.
Aaron D. Fox
Electronic health records of all formerly incarcerated patients seen at the clinic between July 2009 and September 2014 were analyzed to determine evidence of HCV screening, patients who tested positive for HCV antibodies (anti-HCV) and if those positive for HCV underwent or were recommended for treatment.
Overall, 451 patients were seen at the transitions clinic, of which 70% underwent HCV screening (n = 317) and 33% tested positive for anti-HCV (n = 106). Of those positive for anti-HCV, 88% were evaluated for HCV viremia (n = 93) and 79% of these had confirmed chronic HCV (n = 84).
Among patients with HCV, 57% were referred to a specialist (n = 48), 36% were evaluated (n = 30), 10% began treatment (n = 8) and 6% completed treatment and achieved a sustained virologic response (n = 5).
“Chronic HCV infection was common among transitions clinic patients [and] few were treated and cured,” the researchers wrote. “Patients lost contact with providers before consideration for antiviral therapy.”
Five percent of all 84 patients were reincarcerated over time, 16% waited for better HCV treatments, 6% refused care, 8% transferred care, 12% were too unstable to undergo treatment, 19% had no lapse in care and 32% were lost to follow-up.
“While interferon-free treatment regimens should improve acceptability of treatment, it is clear that access to care, referral for specialist evaluation and the decision to initiate treatment will remain hurdles,” the researchers concluded. “Our findings suggest that robust treatment delivery models, which include supportive services to improve retention in care, will be necessary to increase the proportion of HCV carriers who are treated and cured of their disease.” – by Melinda Stevens
Disclosure: The researchers report no relevant financial disclosures.