1. Hepatitis C In Alaska’s Department of Corrections
Ginger Provo RN
Viral Hepatitis Prevention Coordinator
State of Alaska, Division of Public Health

2. HCV Prevalence in the U.S.
HCV infection is the most common
blood-borne infection.
In the U. S. approximately 3.2 million persons are chronically infected per CDC.
this estimate does not include the incarcerated

3. HCV Prevalence in Alaska
Average annual rate of new HCV cases in Alaska is new cases per 100,000 population or
1.3 % prevalence rate.
Section of Epidemiology receives an average of
932 new reports of hepatitis C infection each year.
In new infections were reported

4. Natural History of HCV
, 513 HCV-infected deaths were reported in Alaska

5. Average Annual Rate of Newly Reported HCV Infections, by Age and Sex — Alaska, 2003–2012

6. HCV in Corrections
Approximately 1%-1.5% of Americans have chronic hepatitis C (HCV) compared to 12-35% of U.S. prison inmates.
CDC Correctional Facilities and Viral Hepatitis Jan. 23, 2014
HCV cases in correctional populations represent about 1/3 of total US HCV cases.
Varan et. al. Hepatitis C Seroprevalence Among Prison Inmates Since 2001: Still High but Declining. Public Health Reports, 2014; 129:

7. Correctional Facilities in Alaska
Alaska has 13 jails and prisons
•Anchorage Correctional Complex
•Anvil Mountain Correctional Center
•Fairbanks Correctional Center
•Goose Creek Correctional Center
•Hiland Mountain Correctional Center
•Ketchikan Correctional Center
•Lemon Creek Correctional Center
•Mat-Su Pretrial
•Palmer Correctional Center
•Point Mackenzie Correctional Farm
•Spring Creek Correctional Center
•Wildwood Correctional Center
•Yukon Kuskokwim Correctional Center

8. Alaska’s Inmate Population 2004 - 2021
Total offender population is projected to grow at an average of 1.93% annually
for the next 5 years.
*Figures based on the average annual population 8
Alaska DOC

9. What Percent of Inmates Have HCV Disease?
12-35%
CDC Correctional Facilities and Viral Hepatitis. Jan. 23, 2014
17.4%
Hepatitis C Seroprevalence Among Prison Inmates Since 2001; Still High but Declining.
Public Health Reports. March-April 2014
20-40%
New Hepatitis C Treatments: Considerations and Potential Strategies for States.
National Governors Association Feb. 25, 2015

10. How Much HCV is in Alaska DOC?
Alaska is one of 38 states that do not routinely test inmates on intake.
We do not have an accurate number of HCV infections in AK DOC however DOC estimates that 30% of inmates are infected.
Alaska State Virology Laboratory (ASVL) in Fairbanks conducts hepatitis testing for DOC.

11. Who Gets Tested For HCV in DOC?
Any inmate can request testing
Testing by risk factors:
History of injection drug use (IDU)
Tattoos
Included in STD testing
Clinical findings of liver disease

12. Risk Factors for HCV in DOC
52 inmates in prison or halfway houses were included in the Rapid HCV Testing Project
Prison inmates could be tested if they were within 30 days of release or in a halfway house
22 Tattoo / piercing
20 IDU
4 High risk sexual practices
2 Baby Boomer cohort
4 unknown
were

13. HCV Testing in DOC
Of the 6359 inmates tested for HCV between , 1507 or 19% tested positive for hepatitis C antibody meaning they had been infected with the virus at some time.

14. HCV Testing Results In/Out of DOC

15. Percent Positive HCV Antibody Tests

16. Is HCV in DOC on the Decline?
“The highest rate of HCV disease is in the Baby Boomer cohort (born between ) - this population is aging out of DOC – thus the rate of HCV in DOC is declining.”
Varan et. al. Hepatitis C Seroprevalence Among Prison Inmates Since 2001: Still High but Declining. Public Health Reports, 2014; 129:

17. Positive Tests by Age/Sex 2009-14

19. Approximately 30% of Alaska’s 5000 inmates are infected with hepatitis C on any given day.
Approximately 95% of Alaska’s inmates will eventually be returned to the community.

20. What Would it Cost to Treat These Inmates Today?
~ 5000 inmates in AK DOC
~ 30% are infected
5000 x 30% = 1500 – 25% (375) = 1125
Cost of treatment meds = $95,000 per inmate
1125 X $95,000 = $106,875,000.00

21. Who Gets Treated? Prioritized Critical High Guarded
Advanced liver disease
Continued care from outside
High
Co-infected HIV / HBV /advanced liver disease
Guarded
Post transplant
Decompensated liver disease
Routine Surveillance
Stable disease
Recent infection <5-10 years

22. In Summary Hepatitis C is the #1 blood-borne disease
~ 1.3% of Alaskans are infected
~ 30% of Alaska’s inmates are infected
Main transmissions routes: IDU and tattooing
Inmates can be tested and treated for HCV
New treatments cure hepatitis C – at a CO$T!
Treatment is allocated by severity of disease

23. Thank you!
Ginger Provo RN Nurse Epidemiologist Viral Hepatitis Prevention Coordinator
May is Hepatitis Awareness Month