ACCP Position Paper on the Funding of Hepatitis C Treatment

I recently published the official position paper of the American College of Correctional Physicians (ACCP) on the treatment of Hepatitis C in incarcerated patients (found here). However, some state legislatures (and others who which authorize funds for inmate medical care), have been reluctant to fully fund Hepatitis C treatment. Because of this, ACCP has formally approved the following Position Paper to encourage full funding of HepC treatment among incarcerated inmates.

Because of the medical and public health benefits of HCV treatment, it is the position of the American College of Correctional Physicians (ACCP) that all patients with chronic Hepatitis C infection (HCV) should be treated, with few exceptions, whether in the community or in a correctional facility (ACCP Position Paper on Hepatitis C Infection). 

The most important barrier to accomplishing this goal has been a lack of sufficient funding for HCV treatment from many state legislatures, the Federal Government and others responsible for inmate medical care. ACCP believes that these funding agencies have an ethical responsibility to fund treatment for HCV infection. There is compelling medical, public health, legal and fiscal evidence to support treatment of inmates with HCV infection.

HCV is caused by a virus that, over time, causes progressive liver disease, often leading to liver failure, hepatic cancer, liver transplantation and death.  Treatment of HCV infection using Direct Acting Antiviral agents (DAAs) results in complete eradication of the virus over a few weeks with minimal, if any, side effects in well over 90% of patients.  Research has shown that HCV treatment with DAAs reduces mortality and morbidity at all stages of the disease.  Based on the fact that we have a well-tolerated cure for a serious disease, there is unanimous agreement among various medical societies that all HCV patients (with few exceptions) should be offered this therapy.

Hepatitis C is a communicable disease.  Untreated HCV patients transmit HCV to other people.  Eradicating the virus in patients who have HCV will prevent these individuals from transmitting the disease to others.  Since the incidence of HCV infection is much higher in incarcerated inmates (15-40%) versus the general public (1-2%), jails and prisons are an ideal place to find HCV patients through routine screening, to supervise their treatment and to verify virologic cure.  Successfully treated HCV patients will then not infect others when released from jail or prison.

The Courts have long established that incarcerated inmates have a right to medical care of serious medical conditions.  More recently, class action lawsuits have been filed in many states arguing that failing to treat HCV infections is a violation of inmate rights.  These have generally been successful in forcing states to treat more inmates for HCV infection.

The cost of treating HCV with DAAs has fallen markedly since DAAs were first introduced. The evidence shows that treating incarcerated inmates with DAAs will save money in the long term by preventing the complications of progressive liver disease, cancer, liver transplant and end of life care (https://www.hcvguidelines.org/evaluate/cost).  Also, treating inmates with HCV now will reduce substantial legal costs by avoiding needless defense of inevitable lawsuits.  In addition, some jails and prisons have been able to negotiate even lower prices by participating in pharmaceutical supplier contracts.

Underfunding HCV treatment also puts correctional medical professionals in a position of having to ration medical care. It is unethical and wrong for those funding correctional health care to require correctional physicians to make such decisions.  Correctional practitioners are not asked to do such rationing for other chronic disease states such as HIV or cancer. 

The American College of Correctional Physicians strongly encourages full funding of treatment for inmates with chronic Hepatitis C infection.   

Both ACCP position papers can be found at their website here.

Do you have an opinion as to the funding and treatment of Hepatitis C among incarcerated inmates? If so, please comment!

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