This document summarizes a pilot program that integrated hepatitis C virus (HCV) screening within an existing HIV counseling, testing, and referral (CTR) framework at the Barnstable County House of Corrections in Massachusetts. Key findings included that HCV screening was highly accepted when paired with HIV screening, HCV prevalence among inmates was high, and pairing the screenings increased HIV testing rates. Next steps discussed expanding integrated HCV/HIV screening and prevention to other correctional facilities in Massachusetts.

1. Integrating HCV Screening
within an HIV CTR Framework:
Highly Accepted Intervention in a
Cohort of Inmates/Detainees
Developed By: Eduardo Nettle Presented By: Bernadette Green
Office of HIV/AIDS Office of HIV/AIDS
Bureau of Infectious Disease Bureau of Infectious Disease
Massachusetts Department of Public Health Massachusetts Department of Public Health
Vicki Sherwin
Barnstable County Sheriff’s Department
National HIV Prevention Conference
2011 Atlanta, GA

2. Acknowledgments
Barnstable County Sheriff’s Department
Vicki Sherwin, Infectious Disease Coordinator
Steven Descoteaux, Medical Director
Kathie Porteous, Assistant Deputy Superintendent of Inmate
Services
Massachusetts Department of Public Health (MDPH)
Bureau of Infectious Disease (BID), Office of
HIV/AIDS (OHA)
Dawn Fukuda, OHA Director
Research and Evaluation Unit
Maura Driscoll
Dieu Huynh
National HIV Prevention Conference
2011 Atlanta, GA

3. Presentation Objectives
Provide an overview of the HCV screening pilot at
Barnstable County House of Corrections (BCHC)
Review initiative findings
Discuss implications of integrating HCV/HIV
screening for:
health education, risk reduction (HE/RR) activities
support services during incarceration and post-release
linkage to care post-release
National HIV Prevention Conference
2011 Atlanta, GA

4. Initiative Background
There is a high burden of infectious diseases in
incarcerated/detained populations
Many individuals at high risk for infectious diseases
cycle in and out of jails
Incarcerated individuals tend to be marginalized and
disengaged from medical care prior to incarceration
Inmates and detainees report significant levels of high
risk sexual and injection drug use (IDU) behaviors
National HIV Prevention Conference
2011 Atlanta, GA

5. Background continued…HIV
HIV prevention, screening, medical case management,
and post-release planning are well established in MA
jails and prisons
HIV seropositivity testing rate in MA correctional
settings is fairly low at .3% *
MDPH proposed inquiry about reasons for low HIV
prevalence given inmate/detainee behavioral risk
profile
*Data Source: MDPH/BID-OHA CTRS in Jails/ Prison
CY2010
National HIV Prevention Conference
2011 Atlanta, GA

6. Background continued…HCV
Trends in patient practice at the local and national
levels are shifting toward integration across disease
areas
MDPH funded community-based organizations are
already integrating screening for HCV and other
diseases
There has been a recent increase in new HCV cases in
MA among young people (15 - 24 )
BCHC actively supported the delivery of HCV
screening to individuals in their custody
National HIV Prevention Conference
2011 Atlanta, GA

7. Hypotheses Leading to the Pilot
Pairing HCV and HIV testing may reduce
stigma
Pairing HCV and HIV testing may increase the
rate of inmates/detainees who test for HIV
Offering integrated testing in this setting would
result in finding a high rate of HCV and HIV
positivity among young male IDU
National HIV Prevention Conference
2011 Atlanta, GA

8. Barnstable County House of
Corrections (BCHC)
Located in Cape Cod, Southeastern MA
Facility books ≤ 2800 individuals annually
Average daily count of about 500 inmates
Male to female ratio is 11:1
Average sentence length is 18 months
Facility provides about 500 HIV test per year
with ≤ 1% positivity
National HIV Prevention Conference
2011 Atlanta, GA

9. HCV Integration: Pilot Objectives
Assess acceptability of HCV screening when paired
with HIV screening
Provide comprehensive viral hepatitis education with a
focus on hepatitis C and liver health, especially for
inmates testing HCV+
Link HCV+ inmates with post-release primary and
specialty follow-up care
Enhance HIV prevention and health promotion
opportunities by screening for HCV infection in an
inmate/detainee population
National HIV Prevention Conference
2011 Atlanta, GA

10. HCV Integration within HIV CTRS
Framework
Pilot started in July 2009 and is ongoing
Opt-in HIV and HCV screenings are offered
routinely throughout the period of
incarceration/detention
Access to these services is first offered during
the medical section of orientation - a mandated
activity for all new inmates/detainees
National HIV Prevention Conference
2011 Atlanta, GA

11. Integration continued…
Viral hepatitis and HIV educational group
sessions are offered to the population in custody
Additional support services focusing on liver
health and risk reduction are provided to
inmates testing HCV+
Linkage to community-based medical providers
is initiated during incarceration and continued
post-release for HCV+ ex-offenders
National HIV Prevention Conference
2011 Atlanta, GA

12. Lessons Learned
(July 2009 - December 2010)
HCV screening when paired with HIV screening is
highly accepted by inmates and detainees
HCV screening in this population yields high
prevalence of HCV
All HCV+ cases identified in this time period tested for
the first time through this initiative
There were five HCV indeterminate cases; potential for
identification of early HCV
HIV testing seems to increase when paired with HCV
screening
National HIV Prevention Conference
2011 Atlanta, GA

13. Lessons Learned continued…
The predominant risk behavior among this
cohort was injection drug use (IDU)
40% injected within 12 months prior to testing
49% reported ever injecting
Of the HCV+ inmates/detainees:
43% were young IDUs between the ages 18-29
15% were white females
Of the probable HCV+ inmates/detainees:
85% were white non-Hispanic
National HIV Prevention Conference
2011 Atlanta, GA

14. Implications for HE/RR and
Support Services
Integration of HCV prevention and screening within the
framework of HIV is feasible and highly accepted
Jail settings present a unique opportunity to intensify HCV
and HIV prevention and health promotion efforts focusing
on adolescent and young adult IDUs
There is a need to develop comprehensive HE/RR services
that are responsive to the needs of reintegrating ex-
offenders
Supporting newly identified HCV+ individuals during
incarceration greatly increases likelihood of follow-up care
and integration of health promoting behaviors post-release
National HIV Prevention Conference
2011 Atlanta, GA

15. Next Steps
MDPH/BID-OHA plans to:
expand the number of Massachusetts houses of
corrections providing HCV screening in the fall of
2011
explore the dynamics that seem to increase HIV
testing rates when paired with HCV testing
develop guidance to inform policy regarding
HCV/HIV integration activities in short-term
incarceration settings
National HIV Prevention Conference
2011 Atlanta, GA

16. For questions/comments please
contact:
Eduardo E. Nettle
Eduardo.Nettle@state.ma.us
National HIV Prevention Conference
2011 Atlanta, GA