An additional barrier to HCV diagnosis among PWID is the sporadic and fragmented nature of their health care.4, 5 From an epidemiologic and interventional viewpoint, the correctional system is an appropriate sentinel site to assess both chronic and acute HCV infections among PWID. The seroprevalence rates of chronic HCV infection among incarcerated populations range from 25% to 41%, approximately LY2157299 ic50 20-fold higher than in the community.6, 7 Many inmates entering state prisons are also at risk for acute infection; in one survey, 57%
acknowledged using drugs in the month prior to their incarceration.6 Because the majority of inmates are released into the community within 2 years of sentencing, a meaningful impact on public health could be made through focused preventive and therapeutic measures within this hard-to-reach patient population.8 Yet many correctional medical programs do not screen for HCV infection among persons at risk, despite surveillance recommendations by the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine.9, 10 In a prior pilot project, we identified 21 inmates with acute HCV infection selleck kinase inhibitor over a 30-month period, the majority of whom were referred for symptomatic disease.11 Because most newly infected persons have minimal symptoms, these cases likely represented the tip of the iceberg.12 Furthermore, most of these patients were Caucasian,
although African Americans made up
approximately 25% of the prison population.13 We postulated that underdiagnosis of acute HCV infection in learn more racial/ethnic groups could be related to differences in injection drug use (IDU), lower rates of symptomatic disease, or poorer utilization of health care.11 Motivated by these pilot data, our objective was to determine whether active case finding, using a low-cost screening intervention for high-risk behaviors, would enhance identification of asymptomatic acute HCV infection among newly incarcerated PWID in a “real-life” setting, where health care resources are limited. Moreover, we aimed to elucidate the racial/ethnic profile of those at risk for acute HCV. ALT, alanine aminotransferase; CDC, Centers for Disease Control and Prevention; CI, confidence interval; DPH, Department of Public Health; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IDU, injection drug use; MCI, Massachusetts Correctional Institute; NHANES, National Health and Nutritional Examination Survey; OR, odds ratio; PWID, people who inject drugs; ULN, upper limit of normal. This study was performed at two separate facilities: Massachusetts Correctional Institute (MCI)-Concord for male inmates and MCI-Framingham for female inmates. All admitted prisoners who underwent a medical evaluation were eligible for screening. Self-reported race/ethnicity data were collected upon incarceration.