Morris Meghan D, Brown Brandon, Allen Scott A
Department of Epidemiology & Biostatistics, University of California, San Francisco , San Francisco, California, USA.
Center for Health Communities, University of California, Riverside , Riverside, California, USA.
Int J Prison Health. 2017 Sep 11;13(3-4):192-199. doi: 10.1108/IJPH-07-2016-0028.
Purpose Worldwide efforts to identify individuals infected with the hepatitis C virus (HCV) focus almost exclusively on community healthcare systems, thereby failing to reach high-risk populations and those with poor access to primary care. In the USA, community-based HCV testing policies and guidelines overlook correctional facilities, where HCV rates are believed to be as high as 40 percent. This is a missed opportunity: more than ten million Americans move through correctional facilities each year. Herein, the purpose of this paper is to examine HCV testing practices in the US correctional system, California and describe how universal opt-out HCV testing could expand early HCV detection, improve public health in correctional facilities and communities, and prove cost-effective over time. Design/methodology/approach A commentary on the value of standardizing screening programs across facilities by mandating all facilities (universal) to implement opt-out testing policies for all prisoners upon entry to the correctional facilities. Findings Current variability in facility-level testing programs results in inconsistent testing levels across correctional facilities, and therefore makes estimating the actual number of HCV-infected adults in the USA difficult. The authors argue that universal opt-out testing policies ensure earlier diagnosis of HCV among a population most affected by the disease and is more cost-effective than selective testing policies. Originality/value The commentary explores the current limitations of selective testing policies in correctional systems and provides recommendations and implications for public health and correctional organizations.
目的 全球范围内识别丙型肝炎病毒(HCV)感染者的工作几乎完全集中在社区医疗系统,从而未能覆盖高危人群以及那些难以获得初级医疗服务的人群。在美国,基于社区的HCV检测政策和指南忽视了惩教机构,据信那里的HCV感染率高达40%。这是一个错失的机会:每年有超过1000万美国人进出惩教机构。在此,本文的目的是研究美国惩教系统(加利福尼亚州)中的HCV检测实践,并描述普遍的退出式HCV检测如何能够扩大HCV的早期检测,改善惩教机构和社区的公共卫生状况,并随着时间的推移证明具有成本效益。 设计/方法/途径 一篇关于通过强制要求所有设施(普遍)对所有进入惩教机构的囚犯实施退出式检测政策来规范各设施筛查项目价值的评论。 发现 当前设施层面检测项目的差异导致各惩教机构的检测水平不一致,因此难以估计美国HCV感染成年人的实际数量。作者认为,普遍的退出式检测政策能确保在受该疾病影响最严重的人群中更早地诊断出HCV,并且比选择性检测政策更具成本效益。 原创性/价值 该评论探讨了惩教系统中选择性检测政策目前的局限性,并为公共卫生和惩教组织提供了建议和启示。