HCV testing increasing in Canadian correctional centers

Hepatitis C testing has increased in recent years among people who are incarcerated in provincial correctional centers in British Columbia, Canada, according to new data.

“Sufficient levels of HCV testing and treatment in prisons and other correctional settings is essential to support people living with HCV who experience incarceration,” Sofia Bartlett, PhD, senior scientist for sexually transmitted and blood-borne infections in the clinical preventive services line at the British Columbia Centre for Disease Control (BCCDC), said during a poster presentation at The Liver Meeting Digital Experience. “The data are really lacking on the overall proportion of prison entrants who receive HCV testing across Canada, but globally, this is also a gap in the data.”

Study aims

Bartlett and colleagues conducted their study to determine the proportion of people entering British Columbia provincial correctional centers who received an HCV test each year and to identify changes in treatment patterns during the COVID-19 pandemic as well as after the responsibility for health services in all 10 provincial correctional centers in British Columbia transferred from the Ministry of Public Safety and Solicitor General to the Ministry of Health Provincial Health Services Authority (PHSA) program in October 2017.

This transfer, Bartlett noted, occurred after several reports highlighted deficiencies in the standard of care being provided in provincial correctional centers from a private company contracted by the Ministry of Public Safety and Solicitor General.

For the study, Bartlett and colleagues analyzed data from the BCCDC Public Health Laboratory, which performs more than 95% of all HCV antibody tests and more than 99% of all HCV RNA and genotyping tests in the province since 1990, that are integrated into the BCCDC Sexually Transmitted and Blood-Borne Infection DataMart of the Public Reporting Data Warehouse. Specifically, they evaluated the number of HCV antibody, RNA and genotype tests that were ordered from provincial correctional centers from April 1, 2011, to March 1, 2021, as well as the number of new HCV diagnoses in which it was the first time that a person had returned a positive result from a test ordered from a provincial correctional center.

Overall increase in HCV testing

Results showed that the number of HCV antibody, RNA and genotype tests ordered from provincial correctional centers increased by 412%, 530% and 827%, respectively, in the first quarter of 2020, as compared with the first quarter of 2017, before the transfer of health services to the PHSA program. Importantly, Bartlett said, the highest number of HCV antibody and genotype tests ordered during that 10-year period was highest in mid-March 2020, just before a state of emergency was declared due to COVID-19.

“We believe these data support the fact that the transfer of health services to PHSA improved care overall for people in provincial correctional centers but particularly for the status of their care with regard to HCV and other sexually transmitted and blood-borne infections,” Bartlett said.

During the COVID-19 pandemic, the number of HCV antibody, RNA and genotype tests ordered from provincial correctional centers decreased by 66%, 67% and 68%, respectively, in the second quarter of 2020, as compared with the first quarter of 2020.

“Encouragingly, it’s creeping back up and, in fact, the number of new anti-HCV tests is almost back to the level that it was before the COVID-19 pandemic actually started,” Bartlett said.

Another interesting trend, Bartlett noted, is that the number of new diagnoses actually follows the number of tests being ordered.

“When more tests are ordered, more new diagnoses are made, and that’s a first signal that, in fact, there are more people still yet to be diagnosed in provincial correctional centers,” Bartlett said. “If we saw the number of tests increasing but the number of new diagnoses was remaining stable, then we would be more willing to accept that perhaps there’s not many more people who need to be diagnosed.”

More research necessary

The researchers also assessed the tests as a proportion of intakes to the correctional centers. In 2019, the proportion was 17%, which increased to 23% in 2020, according to the data. Notably, the number of intakes has been tracking down, with a significant decrease in the total number of intakes in 2020. Bartlett noted that this was due to risk mitigation strategies, including decarceration for certain offenders, employed as part of the COVID-19 pandemic response.

“Despite the lower number of people entering provincial correctional centers over 2020, we still had very high numbers of HCV testing, so while the decarceration strategies employed might have mitigated COVID-19, they did not seem to cause any interruptions in the correctional centers to sexually transmitted and blood-borne infection care during the COVID-19 pandemic,” Bartlett said. “While we see overall that HCV testing coverage among people provincially incarcerated in British Columbia has increased in the last 3 years, it still might not really be high enough to facilitate having HCV elimination strategies in provincial correctional centers.”

Moving forward, Bartlett said integrating more data between correctional health services and laboratory testing data will help answer lingering questions as well as help researchers understand where the gaps are in testing and the care that is currently being provided.