High prevalence of hepatitis C virus infection among incarcerated persons: Results from the Louisiana Hepatitis C Elimination Plan's opt-out testing program in prisons

In the United States, modelling studies suggest a high prevalence of hepatitis C virus (HCV) infection in incarcerated populations. However, limited HCV testing has been conducted in prisons. Through the Louisiana Hepatitis C Elimination Plan, persons incarcerated in the eight state prisons were offered HCV testing from 20 September 2019 to 14 July 2022, and facility entry/exit HCV testing was introduced. Multivariable logistic regression was used to evaluate associations with HCV antibody (anti-HCV) positivity and viremia. Of 17,231 persons in the eight state prisons screened for anti-HCV, 95.1% were male, 66.7% were 30–57 years old, 3% were living with HIV, 68.2% were Black and 2904 (16.9%) were anti-HCV positive. HCV RNA was detected in 69.3% of anti-HCV positive individuals tested. In the multivariable model, anti-HCV positivity was associated with older age including those 30–57 (odds ratio [OR] 3.53, 95% confidence interval [CI] 2.96–4.20) and those ≥58 (OR 10.43, 95% CI 8.66–12.55) as compared to those ≤29 years of age, living with HIV (OR 1.68, 95% CI 1.36–2.07), hepatitis B (OR 1.83, 95% CI 1.25–2.69) and syphilis (OR 1.51, 95% CI 1.23–1.86). HCV viremia was associated with male sex (OR 1.89, 95% CI 1.36–2.63) and Black race (OR 1.42, 95% CI 1.20–1.68). HCV prevalence was high in the state prisons in Louisiana compared to community estimates. To the extent that Louisiana is representative, to eliminate HCV in the United States, it will be important for incarcerated persons to have access to HCV testing and treatment.