Hepatitis C and the correctional population.

The hepatitis C epidemic has extended well into the correctional population where individuals predominantly originate from high-risk environments and have high-risk behaviors. Epidemiologic data estimate that 30% to 40% of the 1.8 million inmates in the United States are infected with the hepatitis C virus (HCV), the majority of whom were infected before incarceration. As in the general population, injection drug use accounts for the majority of HCV infections in this group--one to two thirds of inmates have a history of injection drug use before incarceration and continue to do so while in prison. Although correctional facilities also represent a high-risk environment for HCV infection because of a continued high incidence of drug use and high-risk sexual activities, available data indicate a low HCV seroconversion rate of 1.1 per 100 person-years in prison. Moreover, a high annual turnover rate means that many inmates return to their previous high-risk environments and behaviors that are conducive either to acquiring or spreading HCV. Despite a very high prevalence of HCV infection within the US correctional system, identification and treatment of at-risk individuals is inconsistent, at best. Variable access to correctional health-care resources, limited funding, high inmate turnover rates, and deficient follow-up care after release represent a few of the factors that confound HCV control and prevention in this group. Future efforts must focus on establishing an accurate knowledge base and implementing education, policies, and procedures for the prevention and treatment of hepatitis C in correctional populations.