Where is the US Hepatitis C Epidemic *Now*? Putting the “Pen” on the Map as Elimination Efforts Hunt for Remaining Cases.

Abstract

Background. Hepatitis C disease (hepC) is unevenly distributed both by geography and subpopulation. Our 2013 US prisons survey led to an estimate of 17.4% anti-HCV prevalence in 2006. The10M persons who pass through jails and prisons each year bear 30-50% of disease burden, but are excluded from traditional sources of surveillance data, such as NHANES. CDC estimates 50% of persons with hepC lack knowledge of infection in life, thus death data are also imperfect. Data for corrections would enrich understanding of geographic representation of hepC. Methods. In 11/2016, we surveyed state prison medical directors, providers and testers, for data on non-targeted screening of prisoners between 2010-2016. Non-responders were phoned for information. Sizes of state prison populations came from the Bureau of Justice Statistics. Via published reports, we obtained data on jail prevalence. Estimates of the contribution to the national hepC in prison epidemic came from weighting the size of the prison population of the states with prevalence data. Results. As the map (Figure 1) shows, 50% of contiguous states performed non-targeted screening for anti-HCV prevalence in corrections. States with either jail or prison data held 65% of all state prisoners. Seroprevalence ranged from 7.5% to 39.7%. The 2015 prevalence in state prisoners nationwide, weighting by population size, was 18%. Prevalence in states has fuctuated substantially. (Figure 2) Conclusion. Data from penitentiaries allow us to estimate an 18% prison anti-HCV prevalence nationwide, which varies by state and time. Better checks for uniformity in reporting in the future, such as how known positives are handled, would improve data quality. Correctional systems that routinely screen provide real-time data on new trends in hepC distribution, which will help ongoing efforts to treat and eliminate hepC. Such data could improve estimates based on NHANES and death data. Over 99% of persons entering jails and prisons leave, so the correctional epidemic closely infuences the community epidemic. Adding hepC data from the Federal Bureau of Prisons, which tests persons entering from every state, will further inform our understanding of the changing geographic distribution of hepC, and, by proxy, the underlying opioid epidemic.