Year of Publication
Master of Public Health (M.P.H.)
Sarah Wackerbarth, PhD
David Mannino, MD
Julia Costich, JD, PhD
The United States and the Commonwealth of Kentucky are currently overwhelmed by a triad of complex epidemics—incarceration, opioid overdose deaths secondary to substance use disorders, and hepatitis C. Research has suggested hepatitis C screening and treatment of prisoners may be a cost-effective strategy to address the hepatitis C epidemic. Since Kentucky has been particularly impacted by these interrelated health threats, further exploration of hepatitis C in Kentucky prison populations and their potential role in addressing these epidemics is warranted.
The main goal of this research was to examine hepatitis C screening and treatment policy and practice within the Kentucky correctional system, specifically among prisoners, as a potential target for multidisciplinary interventions to combat the substance use disorder and hepatitis C epidemics and prevent HCV transmission.
Scholarly and grey literature sources as well as publicly available data sources and resources about hepatitis C screening and treatment in Kentucky correctional populations were reviewed for initial analysis of pertinent policy and practice applicable to Kentucky prisoners.
Hepatitis C prevalence among Kentucky prisoners estimated overall mean (95% CI) was 25.8% (14.5%-37.1%), nearly 16 times that of Kentucky non-institutionalized adults, and estimates of the number of infected persons include: 5,598 (3,146-8,051 95% CI) infected Kentucky state and federal prisoners; 4,993 (2,806-7,181 95% CI) infected Kentucky prison admissions; and 4,776 (2,679-6,854 95% CI) infected Kentucky prison releases. There may be an estimated 3,967-4,568 undiagnosed hepatitis C infected prisoners in Kentucky. From 2010-2013, about one third (n=1,205, 32.4%) of the 3,724 Kentucky state prisoners screened for hepatitis C were confirmed positive, but only 175 (14.5%) started treatment, leaving 1,030 (85.5%) untreated. Kentucky prisoner screening and treatment cost estimates were from $2.20 million ($1.41-$2.99 million 95% CI) and $200 million ($112-$287 million 95% CI) at 50% discount for releasees, respectively, to up to $4.89 million ($3.12-$6.65 million 95% CI) for one-time screening of both current prisoners and 2017 admissions with $887 million ($498 million – $1.28 billion 95% CI) for treatment of infected cases. If the entire Kentucky Department of Corrections medical services budget was used solely to purchase HCV treatment regimens based on per patient hepatitis C treatment cost estimates, it could cover the following mutually exclusive options: 681 treatment regimens at the $83,735 Kentucky Medicaid cost; 909 treatment regimens at a 25% discounted cost of $62,801; or 1,363 treatment regimens at a 50% discounted cost of $41,868. If the 1,030 untreated prisoners from 2010-2013 infected 1,030 community members upon release, costs to screen and treat the new cases could be up to $89.2 million. If left untreated, the lifetime healthcare costs for hepatitis C in the 1,030 prisoners and 566-875 new community cases of chronic hepatitis C could be $160-$191 million.
For prisoners to become part of the solution of this triad of epidemics, Kentucky must strive for creative funding sources, and effective collaboration, integration of services, and multi-disciplinary interventions.
Kranz, Charity Faith, "Hepatitis C Screening and Treatment of Prisoners: Analysis of Policy and Practice in Kentucky" (2017). Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.). 173.