hepatitis c in alaska’s department of corrections ginger provo rn viral hepatitis prevention...

Hepatitis C In Alaska’s Department of Corrections

Ginger Provo RNViral Hepatitis Prevention Coordinator

State of Alaska, Division of Public Health

HCV Prevalence in the U.S.

• HCV infection is the most common blood-borne infection.• In the U. S. approximately 3.2 million persons

are chronically infected per CDC. – this estimate does not include the incarcerated

HCV Prevalence in Alaska

• Average annual rate of new HCV cases in Alaska is 133.8 new cases per 100,000 population or

1.3 % prevalence rate.

• Section of Epidemiology receives an average of 932 new reports of hepatitis C infection each year.

• In 2014 1149 new infections were reported

2000-2013, 513 HCV-infected deaths were reported in Alaska

Natural History of HCV

Average Annual Rate of Newly Reported HCV Infections, by Age and Sex — Alaska, 2003–2012

HCV in Corrections

• Approximately 1%-1.5% of Americans have chronic hepatitis C (HCV) compared to 12-35% of U.S. prison inmates.

CDC Correctional Facilities and Viral Hepatitis Jan. 23, 2014

• HCV cases in correctional populations represent about 1/3 of total US HCV cases.

Varan et. al. Hepatitis C Seroprevalence Among Prison Inmates Since 2001: Still High but Declining. Public Health Reports, 2014; 129: 187-195.

Correctional Facilities in Alaska

Alaska has 13 jails and prisons

•Anchorage Correctional Complex•Anvil Mountain Correctional Center•Fairbanks Correctional Center•Goose Creek Correctional Center•Hiland Mountain Correctional Center•Ketchikan Correctional Center•Lemon Creek Correctional Center•Mat-Su Pretrial•Palmer Correctional Center•Point Mackenzie Correctional Farm•Spring Creek Correctional Center•Wildwood Correctional Center•Yukon Kuskokwim Correctional Center

8

Alaska’s Inmate Population2004 - 2021

8Alaska DOC

Total offender population is projected to grow at an average of 1.93% annually for the next 5 years. *Figures based on the average annual population

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 20220

1000

2000

3000

4000

5000

6000

7000

3,182 3,254 3,446 3,492 3,707 3,534 3,753 3,835 3,853

4,977 5,038

5,135 5,234 5,335 5,438 5,543 5,650 5,759 5,870

CapacityPopulation

What Percent of Inmates Have HCV Disease?

• 12-35%– CDC Correctional Facilities and Viral Hepatitis. Jan. 23, 2014

• 17.4%– Hepatitis C Seroprevalence Among Prison Inmates Since 2001; Still High but Declining.

Public Health Reports. March-April 2014

• 20-40%– New Hepatitis C Treatments: Considerations and Potential Strategies for States. National Governors Association Feb. 25, 2015

How Much HCV is in Alaska DOC?

• Alaska is one of 38 states that do not routinely test inmates on intake.

• We do not have an accurate number of HCV infections in AK DOC however DOC estimates that 30% of inmates are infected.

• Alaska State Virology Laboratory (ASVL) in Fairbanks conducts hepatitis testing for DOC.

Who Gets Tested For HCV in DOC?

• Any inmate can request testing• Testing by risk factors:

• History of injection drug use (IDU)• Tattoos• Included in STD testing

• Clinical findings of liver disease

Risk Factors for HCV in DOC

• 52 inmates in prison or halfway houses were included in the Rapid HCV Testing Project– Prison inmates could be tested if they were within 30 days

of release or in a halfway house

• 22 Tattoo / piercing• 20 IDU• 4 High risk sexual practices• 2 Baby Boomer cohort• 4 unknown

HCV Testing in DOC 2009-2014

Of the 6359 inmates tested for HCV between 2009-2014,1507 or 19% tested positive for hepatitis C antibody meaning they had been infected with the virus at some time.

HCV Testing Results In/Out of DOC

Percent Positive HCV Antibody Tests

Is HCV in DOC on the Decline?

• “The highest rate of HCV disease is in the Baby Boomer cohort (born between 1945-1965) - this population is aging out of DOC – thus the rate of HCV in DOC is declining.”

Varan et. al. Hepatitis C Seroprevalence Among Prison Inmates Since 2001: Still High but Declining. Public Health Reports, 2014; 129: 187-195.

Positive Tests by Age/Sex 2009-14

• Approximately 30% of Alaska’s 5000 inmates are infected with hepatitis C on any given day.

• Approximately 95% of Alaska’s inmates will eventually be returned to the community.

What Would it Cost to Treat These Inmates Today?

• ~ 5000 inmates in AK DOC• ~ 30% are infected • 5000 x 30% = 1500 – 25% (375) = 1125• Cost of treatment meds = $95,000 per inmate

• 1125 X $95,000 = $106,875,000.00

Who Gets Treated?

• Prioritized – Critical

• Advanced liver disease• Continued care from outside

– High• Co-infected HIV / HBV /advanced liver disease

– Guarded• Post transplant• Decompensated liver disease

– Routine Surveillance• Stable disease • Recent infection <5-10 years

In Summary

• Hepatitis C is the #1 blood-borne disease• ~ 1.3% of Alaskans are infected• ~ 30% of Alaska’s inmates are infected• Main transmissions routes: IDU and tattooing• Inmates can be tested and treated for HCV• New treatments cure hepatitis C – at a CO$T!• Treatment is allocated by severity of disease

Thank you!

Ginger Provo RNNurse Epidemiologist

Viral Hepatitis Prevention Coordinatorginger.provo@alaska.gov

907-269-8074

May is Hepatitis Awareness Month

http://www.epi.alaska.gov/id/hepatitis