CANN Hosts 3rd Annual Community Roundtable on Correctional Hepatitis

By: Marcus J. Hopkins, Policy Consultant

Reprinted with Permission from the Community Access National Network (CANN)

On Wednesday, April 17th, the Community Access National Network (CANN) hosted its 3rdAnnual Community Roundtable on Viral Hepatitis in Correctional Settings at the Pharmaceutical Research and Manufacturers of America (PhRMA) headquarters in Washington, DC. Their panel included three presenters: yours truly, along with Wayne  Turner (Senior Attorney at the National Health Law Program), and Todd Schwartz (National Account Director at Gilead Sciences, Inc.). Each presented touched on some facet of the myriad issues faced by inmates living in state correctional facilities, as well as various research efforts, funding mechanisms, and opportunities for improvement.

I presented on viral hepatitis in Correctional Settings, during which I focused on CANN’s two-year research effort focusing on HIV, Hepatitis B (HBV), and Hepatitis C (HCV) testing protocols in state prisons, as well as the declining per inmate cost of HCV treatments, and the state of HCV-related Class-Action lawsuits winding their ways through various courts.

Since 2017, I have been reaching out to Department of Corrections (DOCs) in every state and the District of Columbia on behalf of both CANN and the ADAP Advocacy Association to determine what are the state protocols for testing: Is testing compulsory (required), upon request, or based upon clinical criteria, is it conducted during or after the intake process, can inmates refuse to be tested, and is testing offered using an Opt-In (“informed consent”) or an Opt-Out (“informed refusal”) model of delivery. This research represents only a handful of national efforts to identify state correctional testing protocols and to determine whether or not these protocols will help the U.S. towards reaching its established goals of reaching elimination of HIV and HCV (both by 2030).

As of March 2019, all but seven states either responded to inquiries or had the protocols publicly posted on their respective states’ DOC websites (only 14 states, including two that responded, publicly post their testing protocols). Our findings determined that, while most states (n=34) do a good job of making HIV testing compulsory, only 11 states require HBV testing, and only 22 require HCV testing (Hopkins, 2019).

What is concerning about these findings is that, in Arizona, Alaska, Florida, Kentucky, Maine, and Massachusetts – all areas of the country where Injection Drug Use (IDU) is high, HIV testing is performed only upon request.

For HBV, the testing landscape is, for lack of a better word, “bleak.” Despite having a commercially available vaccine for HBV since 1981 (and recombinant vaccines since 1986), only 50 million adults and 70 million babies in America have received at least one dose of the vaccine since 1982 – roughly 37% of the American population (Immunization Action Coalition, 2017). Because, HBV is transmissible via sexual contact, as well as by IDU, the vaccination recommendations are considerably broad, but because the disease was so rare, physicians in more rural parts of the nation never bothered to vaccinate many Americans. As a result, the U.S. is seeing an increase in new HBV infections in places where the virus was largely absent. With only 11 states requiring HBV testing in state prisons, inmates face a greater risk of encountering this entirely avoidable, yet incurable disease.

For HCV, as the rates of new infections continue to climb, in all ten of the states with the highest rates of new infections, testing is either not compulsory, or there are no protocol data made available.

You can find my report at the following link: Viral Hepatitis in Correctional Settings.

Wayne Turner, Senior Attorney at the National Health Law Program (NHLP), presented on the various ways state Medicaid programs can and cannot be utilized to help cover to cost of treating incarcerated individuals. He discussed the various intricacies of how the Medicaid program defines “inmate” and “incarceration,” as well as issues surrounding eligibility during and after incarceration, linkage to Medicaid during the reentry process, and how Medicaid is structured.

You can find Mr. Turner’s report at the following link: Medicaid, Incarcerated Persons, and Hepatitis C Treatment.

Todd Schwarz, National Account Director at Gilead Sciences, Inc., provided us with an overview of the corrections system, Gilead’s efforts to help with education, HIV and HCV resource location services, education efforts, and statistics related to new infections and prevalence rates within the state correctional healthcare systems.

You can find Mr. Schwartz’s presentation at the following link: Community Roundtable on Linkages to Care for Incarcerated Citizens Living with Hepatitis C – Gilead Focus on Hepatitis C in Corrections.

Contact CANN to learn more.

References:

• Hopkins, M.J. (2019, April 17). Viral Hepatitis in Correctional Settings. Washington, DC: Community Access National Network. Retrieved from: http://www.tiicann.org/urls/2019_CANN_Presentation_1_Hepatitis_Corrections_04-17-19_HOPKINS.pdf
• Immunization Action Coalition. (2017, December). Hepatitis B: Questions and Answers. St. Paul, MN: Immunization Action Coalition: Handouts: Vaccine Index: Hepatitis B. Retrieved from: http://www.immunize.org/catg.d/p4205.pdf
• Schwartz, T. (2019, April 17). Community Roundtable on Linkages to Care for Incarcerated Citizens Living with Hepatitis C – Gilead Focus on Hepatitis C in Corrections. Foster City, CA: Gilead Sciences, Inc. Retrieved from: http://www.tiicann.org/urls/2019_CANN_Presentation_3_Hepatitis_Corrections_04-17-19_SCHWARTZ.pdf
• Turner, W. (2019, April 17). Medicaid, incarcerated persons, and hepatitis C treatment. Washington, DC: National Health Law Program. Retrieved from: http://www.tiicann.org/urls/2019_CANN_Presentation_2_Hepatitis_Corrections_04-17-19_TURNER.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Improving Access to Care Among Formerly Incarcerated Populations with HIV/AIDS under the AIDS Drug Assistance Program

By: Brandon M. Macsata, CEO, ADAP Advocacy Association & Marcus J. Hopkins, HIV/HCV Co-Infection Watch Project Director, Community Access National Network

The ADAP Advocacy Association announced earlier this month that it has launched a new project to improve access to care and treatment for correctional inmates living with HIV/AIDS who are transitioning back into community life. The project – “Improving Access to Care Among Formerly Incarcerated Populations with HIV/AIDS under the AIDS Drug Assistance Program (ADAP)” – aims to raise awareness about issues confronting formerly incarcerated populations living with HIV/AIDS (and/or Hepatitis C) who also access care and treatment (or whom could benefit from such care and treatment) under the AIDS Drug Assistance Program (ADAP), as well as provide useful resources and tools to the communities serving them.

The data on the number of formerly incarcerated populations infected with HIV/AIDS (and/or HCV), in many cases, simply isn’t available. In fact, most states’ epidemiology reports that did report HCV numbers didn’t account for incarcerated populations. What data is available is woefully out of date, using data four years or older. The data on HIV isn’t much better.

The Centers for Disease Control and Prevention (CDC) website, updated on March 14, 2017, cites numbers from 2010 – seven years prior to the most recent update.[1] The data cited is obtained from a 2012 report by the Bureau of Justice Statistics (BJS) – revised in March 2015 – that looked at HIV in prisons and jails from 2001-2010.[2] What used to be an annual report with yearly updates from 1993-2008, has apparently been shelved, over the past decade. Moreover, there doesn’t seem to be much in the way of a replacement from any government agency.

The BJS report indicated a few very important findings:

• In 2010, there were 20,093 inmates in state and federal prisons infected with HIV, representing 1.5% of the total incarcerated population. 3,913 of those inmates were living with an AIDS diagnosis.
• Of the total HIV-infected population, 91% were male. African-American (AA) men were 5 times as likely to be diagnosed than White men, and twice as likely as Hispanic/Latino men. AA women were more than twice as likely to be diagnosed with HIV than both White and Hispanic/Latino women.
• Rates of AIDS-related deaths among state and federal prisoners declined an average of 16% a year from 2001 to 2010, from 24 deaths/100,000 in 2001 to 5/100,000 in 2010.

Other than those numbers, there isn’t a lot of information that is readily available to the public, which is troubling for a number of reasons.
Among them:

1. HIV remains a deadly disease that, when left untreated and/or undiagnosed, can lead to numerous life-threatening complications and death; 
2. Incarceration settings are notorious for being hotbeds of transmission for a host of sexually transmitted diseases; and
3. This failure to present regular data updates may mean that prisons and jails are not complying with regulations requiring that all inmates be screened for HIV.

The CDC does, however, tout support for a number of community-based pilot projects, including Project START, Project Power, a partnership with Emory University (based in Atlanta) focused on juvenile AA girls aged 13-17, and a partnership with Morehouse Medical School to counsel AA male jail inmates about high-risk sexual behaviors and how to reduce them.  These programs are designed to help male and female inmates understand the risk associated with certain behaviors, as well as prevention strategies to be used both within and outside of incarceration settings.

One of the most frustrating aspects of conducting any research is the lack of information available to the public. Disease statistics are the foundation for making good policy at all levels of government, which means that, in order for citizens, legislators, and executives to craft data-driven, meaningful legislation and regulations, these data must be present. The data must be easily accessible, regularly updated (annually), and reliable.  At this point, that data is simply unavailable, which further leads to the need for greater awareness, and clearer guidelines on linkages to care.

What makes this approach vitally important is that access to care and treatment for HIV-infection (and/or HCV) is something that is sorely lacking in the areas that are hardest hit; not just HIV education, really – healthcare literacy in general is an issue. As such, there is a need to work on ways to get people to actually care about their health; help to identify the appropriate linkages to care; and engage in successful care and treatment strategies that will lead them to be Virally Suppressed. 

Available supports and services are going unused in too many ADAP jurisdictions, evidenced by data shared in the 2017 National ADAP Monitoring Project Annual Report (as seen in the charts below).[3] 

There exists a need to raise awareness among key stakeholders – among them, ADAP Directors, community service providers, and state/local advocacy organizations – about existing and emerging issues confronting formerly incarcerated populations. Furthermore, there is a need to model existing best practices to ADAP across the 50 states and territories in the United States. 

To that end, key elements of the project include:

1. Community Forum on Formerly Incarcerated Populations & Provider Friendly Care;

2. Animated Video on Formerly Incarcerated Populations & Linkages to Care;

3. Infographic on Ryan White/ADAP Serving Formerly Incarcerated Populations;

4. White Paper on Model Policy for Ryan White/ADAP Serving Formerly Incarcerated Populations; and

5. Twitter Chat on Ryan White/ADAP Serving Formerly Incarcerated Populations.

The project will execute all of the key elements between September 1, 2017 and March 31, 2018.

To learn more about the ADAP Advocacy Association's Correctional Health Project, please email info@adapadvocacyassociation.org.

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[1]  Centers for Disease Control and Prevention (CDC). (2017, March 14). HIV Among Incarcerated Populations. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention: Division of HIV/AIDS Prevention. Retrieved from: https://www.cdc.gov/hiv/group/correctional.html
[2] Bureau of Justice Statistics. (2012, September 13). HIV in Prisons, 2001-2010 (NCJ 238877). Washington, DC: United States Department of Justice: Office of Justice Programs: Bureau of Justice Statistics. Retrieved from: https://www.bjs.gov/content/pub/pdf/hivp10.pdf
[3] National Alliance of State & Territorial AIDS Directors (2017, May 18); 2017 National ADAP Monitoring Project Annual Report; p. 24. Retrieved from http://www.nastad.org/sites/default/files/2017-national-adap-monitoring-project-annual-report.pdf.