Stopping the Cirrhosis: An international review of Hep C Screening in Prisons and Jails from 2004-2023

Background: As of 2023, HCV prevalence in state prisons in the United States was 9 times higher than the general population1. Without treatment, 20% of people with HCV will develop cirrhosis, and some estimate that 70% of hepatocellular carcinoma (HCC) cases arise from cirrhosis or advanced fibrosis2. Despite the high prevalence in prisons, the US does not have nationally standardized Hep C screening in correctional facilities. The goal of this study is to investigate different models of existing programs in prisons internationally. Understanding these models will inform Hep C screening in US prisons on a state and national level. Methods: PubMed and EMBASE databases were used. Covidence removed duplicates. 2727 abstracts were screened for eligibility according to predetermined inclusion and exclusion criteria and data extraction proforma for full text screening. Results: 62 publications were included. Of these, 4 implemented more than one model. 27% (17) were published in the United States, and 73% (45) published abroad. In terms of screening models, 52% (30/58), 29% (17/58), 5% (3/58), 7% (4/58), 5% (3/58), and 2% (1/58) were screened with opt-out, opt-in, cohort, point-of-care, opt-out cohort, and peer-supported models, respectively. 71% (41/58) of all reviewed studies linked participants to treatment. Conclusion: There is a need to develop and evaluate Hep C screening models in prisons and jails. More investigation within the US is necessary as studies primarily originate on the East Coast and in Texas, and regulations for correctional care vary per state. The opt-out screening model was the most common.