Mass. Settlement Could Speed HCV Testing For Prisoners Nationally

In early March, the Massachusetts Department of Correction reached a settlement with prisoners' rights groups over its medical treatment of prison inmates infected with hepatitis C virus (HCV).

The settlement requires testing every prisoner for HCV and treating all who have the disease. While the Federal Bureau of Prisons recommended opt-out hepatitis C testing for all inmates during the prevention baseline visit, few state prison systems have implemented universal testing. The Massachusetts settlement may speed action in other states.

The National Lawyers Guild and Prisoners' Legal Services filed a class action lawsuit in U.S. District Court in Boston in 2015 on behalf of Massachusetts prisoners who had hepatitis C claiming that the state had reduced the number of patients treated for hepatitis C and delayed evaluating prisoners in order to avoid being responsible for the new, costly treatments.

While the Massachusetts chapter of the National Lawyers Guild says this is believed to be the first settlement of its kind, there are increasingly calls for universal HCV screening of prisoners. Inmates in Indiana, Pennsylvania, Missouri, Minnesota and Tennessee have filed similar lawsuits, according to the Wall St. Journal reports. Public health experts are also calling for increased testing and treatment of incarcerated populations, as they represent a "missed opportunity" for intervention.

The prevalence of HCV is known to be substantially higher in incarcerated populations, compared with the general population (up to 35 percent chronic infection in the correctional population versus 1 percent in the general U.S. population). These numbers may actually underestimate the true disease burden among prisoners due to low HCV screening rates in correctional settings.

According to a 2015 study in the American Journal of Public Health, state corrections system directors reported that only 17 states had at least one state-prison facility offering routine opt-out HCV screening, with eight states having no screening program in place.

HCV screening programs can fall into two main categories: opt-in or voluntary or opt-out or universal. Opt-in policies offer HCV testing only to individuals who specifically ask or who self-disclose as being a member of a risk-based group (e.g. individuals who disclose a history of injecting drugs). Opt-out or universal testing policies test everyone and individuals may choose whether to participate. Previous studies have shows that opt-out HIV testing is popular among both prisoners and staff, with a large majority of prisoners accepting opt-out testing.

"Given the number of people infected with HCV and the length of sentence stay (median stay in the USA was 65 months in 2009), correctional facilities offer a unique opportunity for HCV screening to ensure more people know their status and earlier detection," writes Meghan Morris, from University of California, San Francisco, in a September 2017 article in the International Journal of Prisoner Health. "Early detection and engagement in care can prevent prisoners from unwittingly transmitting HCV to others after re-entering the general community. Universal opt-out HCV screening at entry into prison may result in a dramatic reduction in the number of new HCV infections over the next 30 years, benefits able to extend beyond the prison environment to the general community."

Takeaway: The Massachusetts HCV settlement may accelerate universal, opt-out testing among incarcerated populations, particularly in states with pending litigation regarding HCV treatment for prisoners.