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
- to evaluate clients for chronic liver disease,
- to provide possible treatment,
- to vaccinate against hepatitis B when
- to provide counseling on hepatotoxin
- 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:
- 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.
- There is a high prevalence of hepatitis C in
prisons and jails (prison>jail). The majority of cases are undiagnosed.
- 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.
- 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.
- 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
*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