Early Phase Implementation of Routine Opt Out Hepatitis C Testing in the Philadelphia Jail System

Author: Lora Magaldi Stacey Trooskin Ebonee Allen Jolie Anderson Debra D'Aquilante Reed Domer-Shank Bruce Herdman Eke Kalu Jay Kostman Norman Mueller Maria Nagori Vandelyn Phillips Alexandra Ripkin Ricardo Rivera

Theme: Models of Care Year: 2021

Hepatitis C (HCV) infection disproportionately affects those in United States’ correctional
institutions with seroprevalence rates from 17.4-23.1%. Jails have represented a particularly
challenging setting for HCV testing and treatment given the short duration of stay and
uncertainty of the timing of release. Despite recommendations that all incarcerated persons
undergo HCV testing, screening is not universally performed.
In 2018, 1463 (7.5%) of the 19395 prisoners in Philadelphia jails were screened for HCV at
the time of sentencing. On 3 September 2019 the jail partnered with Philadelphia FIGHT
Community Health Centres to implement routine opt out HCV testing upon intake. Protocols
for testing, result delivery and provider follow up were developed in a collaborative manner
between the jail and FIGHT in August 2019. Herein, we report the findings of the first
eighteen months of routine opt out screening at intake.
Between 3 Sept 2019 and 28 February 2021, 18326 individuals entered the jail. 16934
(92.40%) individuals were tested for HCV antibody (ab) upon entry. 1965 (98.84%) of 1988
ab+ individuals had reflexive RNA confirmatory testing and 1332 (67.79%) were chronically
infected. Of those, 588 were seen by a linkage coordinator, 856 were seen by a jail-based
HCV provider, and 307 individuals were prescribed direct acting agents while incarcerated.
724 (54.35%) had a stay <20 days. Conclusion: Establishment of routine opt out HCV screening in a jail setting resulted in more than 90% of individuals being screened for HCV. Ongoing challenges, presented by the shortened length of stay during a single period of incarceration, include the need for rapid result delivery, the need to increase linkage coordinator visits, and treatment evaluation by a jail-based provider. Collaboration between health care providers in the correctional system and community is necessary to coordinate HCV services in a high volume, high turnover urban jail. Disclosure of Interest Statement: The conference collaborators recognise the considerable contribution that industry partners make to professional and research activities. We also recognise the need for transparency of disclosure of potential conflicts of interest by acknowledging these relationships in publications and presentations.

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