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Adult corrections facilities

North Dakota Department of Corrections and Rehabilitation
Program name: North Dakota Department of Corrections and Rehabilitation
Population served: Inmates in adult correctional facilities
Eligibility: All incoming prisoners
Region served: State of North Dakota
Funding: North Dakota state legislature
Program started: 2001
Number of clients: Approximately 80

Kathleen Bachmeier
Box 5521
Bismarck, ND 58506
Phone: (701) 328-6232
Fax: (701) 328-6307
Email: kbachmei@state.nd.us

Website: None

Brief description of program:

North Dakota DOCR Prisons Division Medical Department approaches the prevention and treatment of hepatitis C as a major public health issue for North Dakota. The abuse of methamphetamine with IV needle usage has paralleled the increase of hepatitis C in our offender population. Approximately, 62% of offenders entering our prison system admit to using methamphetamine. Prevention occurs through a variety of educational offerings and addiction treatment. Screening of all offenders for Hepatitis C and a vaccination program for hepatitis A and B are integral parts of the prevention program. Actual treatment of hepatitis C is done by using Consensus Interferon which affords more offenders the ability to be treated for hepatitis C. Preliminary clinical research results support the proof of concept that Consensus Interferon is at least as effective as Pegintron products.

Main Points of Program:

1) Screening
  1. All incoming prisoners are screened for hepatitis C.
2) Vaccination
  1. All prisoners with >5 year sentences are immunized for hepatitis A and B.
  2. All hepatitis C positive prisoners are immunized for hepatitis A and B.
3) Education for all new prisoners
  1. Orientation
    1. One hour class for all inmates including nursing didactics and video presentation.
    2. Red Cross presentation covering HIV and HCV
  2. Intake physical
    1. Medical staff strongly reiterates warnings and educates further about high-risk behaviors on an individual level.
    2. Opportunity to answer individual questions
  3. If HCV positive, nursing individually gives a pamphlet that discusses the treatment options available to the inmate and answers any questions
4) Treatment
  1. All hepatitis C positive prisoner enter a pre-treatment screening protocol as follows:
    1. Age 18-60
    2. Confirmation hepatitis C RNA with genotype
    3. Immunization and serology confirming immunity to hepatitis A and B
    4. Hgb A1c <9
    5. Adequately treated heart disease
    6. Adequately treated thyroid disease
    7. Absence of renal disease
    8. Absence of decompensated cirrhosis with ascites
    9. Hgb >10 g
    10. Absence of autoimmune disease
    11. Absence of life threatening non-hepatic disease
    12. Satisfactory clinic compliance
    13. If HIV +, recent CD4 count>200
    14. Two negative alcohol and drug tests 6 months apart
    15. Prison stay certain for at least 8 months for genotype 2, 3 once treatment begins
    16. Prison stay certain for at least 14 months for genotype 1 once treatment begins
    17. Female inmate: recent neg. pregnancy test and documentation of counseling in avoiding pregnancy until 6 months after treatment complete
    18. Compliant with drug and alcohol treatment recommendations
    19. Absence of severe Axis I diagnosis or psychiatric clearance for therapy
    20. No body piercing or tattoos for 6 months
  2. If qualify for treatment per the above protocol, then treat as follows:
    1. Genotype 1:
      1. Planned 48 weeks consensus interferon/weight-based ribavirin
      2. at 12 weeks, if 2 log reduction not achieved, then stop therapy
      3. at 24 weeks if qualitative HCV +, then stop therapy
    2. Genotypes 2&3:
      1. 24 weeks of consensus interferon/ribavirin 400 mg BID
5) Results
  1. Efficacy of treatment at least as effective as PegIntron-based regimen
  2. Cost reduction of approximately 40% per patient treated
  3. Since starting consensus-based regimen, we have used no exogenous growth factor (i.e. erythropoietin or GCSF) for anemia or neutropenia
  4. Since starting consensus-based regimen, we have higher rates of hypothyroidism.
  5. No patient has had to stop consensus-based therapy due to side effects.

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