Or contact
Kathy Hudyka, RN
Hampden County Correctional Center
Phone: (413) 547-8000 x2338
Email: kathleen.hudyka@sdh.state.ma.us

In Hampden County, we have used a public health model for corrections to develop a program for hepatitis A, B, and C in our correctional facilities. This model includes: education, prevention, early detection, treatment, and continuity of care.

Our program staff includes four jail health teams integrated with four community (neighborhood) health centers. Patients are assigned to a health team by zip code or prior association with a community health center. Some team members are dually based, physicians and HIV case managers are primarily health center based, and nurses and nurse practitioners are primarily jail based. The physician and case manager continue to follow patients at the community health centers after their release from jail.

The hepatitis B program at HCCC includes: education from the time of admission, including peer education; hepatitis B vaccination for all individuals 25-35 years of age and for all others with negative serology for HBV; encouraging counseling and testing for HIV, and hepatitis B, and C; ALT on admission*; and a vaccination and PPD wallet record card. Serostatus is known from prior records, or can be checked by request or in evaluation of abnormal SGPT or other medical condition. With a background prevalence of hepatitis A antibody at 21%*, and hepatitis A outbreaks in homeless and incarcerated populations in Massachusetts, hepatitis A vaccination for all was instituted and remains the practice.

Hepatitis screening is recommended for several reasons:

1. to evaluate clients for chronic liver disease,
2. to provide possible treatment,
3. to vaccinate against hepatitis B when appropriate
4. to provide counseling on hepatotoxin avoidance, and
5. to provide counseling on transmission prevention (whether infected or not).

An intake study of male and female HCCC inmates for hepatitis C infection found a prevalence rate of 21%*.

Hepatitis, Corrections, and Public Health Implications from HCCC Experience:

1. Correctional health care is a public health opportunity, as almost all detainees come from and return to the community. Providing hepatitis prevention services benefits the individual patient, the public, and the correctional population.
2. There is a high prevalence of hepatitis C in prisons and jails (prison>jail). The majority of cases are undiagnosed.
3. Most detainees have risk factors warranting testing for hepatitis C. The counseling and testing model for HIV can be expanded for HCV. Hepatitis A and B serology at the same time is likely cost effective depending on the background prevalence of prior disease.
4. A fraction of those detainees with hepatitis C meet "consensus" criteria for initiation of interferon-based treatment, but most need education, counseling, and vaccination for hepatitis A and B.
5. Most detainees should be vaccinated against hepatitis B. The vaccinated prevalence in the younger population is increasing and serology and/or better vaccine information retrieval could improve cost effectiveness.

*Footnote: see Viral Hepatitis, Risk Behaviors, Aminotransferase Levels, and Screening Options at a County Correctional Center. Journal of Correctional Health Care, 12(4), October 2006 at http://jcx.sagepub.com/