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Integrating HCV Screening within an HIV CTR Framework: Highly Accepted Intervention in a Cohort of Inmates/Detainees
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Integrating HCV Screening within an HIV CTR Framework: Highly Accepted Intervention in a Cohort of Inmates/Detainees

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  • 1. Integrating HCV Screeningwithin an HIV CTR Framework:Highly Accepted Intervention in a Cohort of Inmates/DetaineesDeveloped By: Eduardo Nettle Presented By: Bernadette GreenOffice of HIV/AIDS Office of HIV/AIDSBureau of Infectious Disease Bureau of Infectious DiseaseMassachusetts Department of Public Health Massachusetts Department of Public HealthVicki SherwinBarnstable County Sheriff’s Department National HIV Prevention Conference 2011 Atlanta, GA
  • 2. AcknowledgmentsBarnstable County Sheriff’s Department Vicki Sherwin, Infectious Disease Coordinator Steven Descoteaux, Medical Director Kathie Porteous, Assistant Deputy Superintendent of Inmate ServicesMassachusetts Department of Public Health (MDPH)Bureau of Infectious Disease (BID), Office ofHIV/AIDS (OHA) Dawn Fukuda, OHA Director Research and Evaluation Unit Maura Driscoll Dieu Huynh National HIV Prevention Conference 2011 Atlanta, GA
  • 3. Presentation ObjectivesProvide an overview of the HCV screening pilot atBarnstable County House of Corrections (BCHC)Review initiative findingsDiscuss implications of integrating HCV/HIVscreening for: health education, risk reduction (HE/RR) activities support services during incarceration and post-release linkage to care post-release National HIV Prevention Conference 2011 Atlanta, GA
  • 4. Initiative BackgroundThere is a high burden of infectious diseases inincarcerated/detained populationsMany individuals at high risk for infectious diseasescycle in and out of jailsIncarcerated individuals tend to be marginalized anddisengaged from medical care prior to incarcerationInmates and detainees report significant levels of highrisk sexual and injection drug use (IDU) behaviors National HIV Prevention Conference 2011 Atlanta, GA
  • 5. Background continued…HIVHIV prevention, screening, medical case management,and post-release planning are well established in MAjails and prisonsHIV seropositivity testing rate in MA correctionalsettings is fairly low at .3% *MDPH proposed inquiry about reasons for low HIVprevalence given inmate/detainee behavioral riskprofile *Data Source: MDPH/BID-OHA CTRS in Jails/ Prison CY2010 National HIV Prevention Conference 2011 Atlanta, GA
  • 6. Background continued…HCVTrends in patient practice at the local and nationallevels are shifting toward integration across diseaseareasMDPH funded community-based organizations arealready integrating screening for HCV and otherdiseasesThere has been a recent increase in new HCV cases inMA among young people (15 - 24 )BCHC actively supported the delivery of HCVscreening to individuals in their custody National HIV Prevention Conference 2011 Atlanta, GA
  • 7. Hypotheses Leading to the PilotPairing HCV and HIV testing may reducestigmaPairing HCV and HIV testing may increase therate of inmates/detainees who test for HIVOffering integrated testing in this setting wouldresult in finding a high rate of HCV and HIVpositivity among young male IDU National HIV Prevention Conference 2011 Atlanta, GA
  • 8. Barnstable County House of Corrections (BCHC)Located in Cape Cod, Southeastern MAFacility books ≤ 2800 individuals annuallyAverage daily count of about 500 inmatesMale to female ratio is 11:1Average sentence length is 18 monthsFacility provides about 500 HIV test per yearwith ≤ 1% positivity National HIV Prevention Conference 2011 Atlanta, GA
  • 9. HCV Integration: Pilot ObjectivesAssess acceptability of HCV screening when pairedwith HIV screeningProvide comprehensive viral hepatitis education with afocus on hepatitis C and liver health, especially forinmates testing HCV+Link HCV+ inmates with post-release primary andspecialty follow-up careEnhance HIV prevention and health promotionopportunities by screening for HCV infection in aninmate/detainee population National HIV Prevention Conference 2011 Atlanta, GA
  • 10. HCV Integration within HIV CTRS FrameworkPilot started in July 2009 and is ongoingOpt-in HIV and HCV screenings are offeredroutinely throughout the period ofincarceration/detentionAccess to these services is first offered duringthe medical section of orientation - a mandatedactivity for all new inmates/detainees National HIV Prevention Conference 2011 Atlanta, GA
  • 11. Integration continued…Viral hepatitis and HIV educational groupsessions are offered to the population in custodyAdditional support services focusing on liverhealth and risk reduction are provided toinmates testing HCV+Linkage to community-based medical providersis initiated during incarceration and continuedpost-release for HCV+ ex-offenders National HIV Prevention Conference 2011 Atlanta, GA
  • 12. Lessons Learned (July 2009 - December 2010)HCV screening when paired with HIV screening ishighly accepted by inmates and detaineesHCV screening in this population yields highprevalence of HCVAll HCV+ cases identified in this time period tested forthe first time through this initiativeThere were five HCV indeterminate cases; potential foridentification of early HCVHIV testing seems to increase when paired with HCVscreening National HIV Prevention Conference 2011 Atlanta, GA
  • 13. Lessons Learned continued…The predominant risk behavior among thiscohort was injection drug use (IDU) 40% injected within 12 months prior to testing 49% reported ever injectingOf the HCV+ inmates/detainees: 43% were young IDUs between the ages 18-29 15% were white femalesOf the probable HCV+ inmates/detainees: 85% were white non-Hispanic National HIV Prevention Conference 2011 Atlanta, GA
  • 14. Implications for HE/RR and Support ServicesIntegration of HCV prevention and screening within theframework of HIV is feasible and highly acceptedJail settings present a unique opportunity to intensify HCVand HIV prevention and health promotion efforts focusingon adolescent and young adult IDUsThere is a need to develop comprehensive HE/RR servicesthat are responsive to the needs of reintegrating ex-offendersSupporting newly identified HCV+ individuals duringincarceration greatly increases likelihood of follow-up careand integration of health promoting behaviors post-release National HIV Prevention Conference 2011 Atlanta, GA
  • 15. Next StepsMDPH/BID-OHA plans to: expand the number of Massachusetts houses of corrections providing HCV screening in the fall of 2011 explore the dynamics that seem to increase HIV testing rates when paired with HCV testing develop guidance to inform policy regarding HCV/HIV integration activities in short-term incarceration settings National HIV Prevention Conference 2011 Atlanta, GA
  • 16. For questions/comments please contact: Eduardo E. Nettle Eduardo.Nettle@state.ma.us National HIV Prevention Conference 2011 Atlanta, GA