Year of Publication

2017

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Sarah Wackerbarth, PhD

Committee Member

David Mannino, MD

Committee Member

Julia Costich, JD, PhD

Abstract

INTRODUCTION

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.

Primary Objective

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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