1064 - Hepatitis C Epidemiology at the Dallas County Jail: A Changing Demographic

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Presenting Author(s)

EH

Emily Hoff

Resident Physician
University of Texas--Southwestern
Dallas, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AW

Andrea E. Warden

Nurse Navigator
Parkland Health and Hospital System
Flower Mound, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RT

Ruby Taylor

Senior Vice President of Nursing, Population Health
Parkland Health and Hospital System
Dallas, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ank E. Nijhawan

Associate Professor
UT Southwestern
Dallas, Texas
Disclosure: Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)

Background: Nearly 1 in 3 people living with HCV pass through the CJ system each year. As a result, the CJ system is a crucial location for Hepatitis C screening, education and linkage to care. We aim to 1) identify the prevalence and incidence of HCV and 2) evaluate HCV demographic trends at a large urban jail.

Methods: Universal opt-out HCV testing was offered in four separate testing cycles from 2015 to 2019 to any individual undergoing a routine blood draw at the Dallas County Jail (N=14490; Figure 1). HCV antibody (Ab) assay (LabCorp) was used with reflex RNA testing added on in 2017. Demographic variables were extracted from the electronic medical record for all tested, with risk factors collected from those who tested positive for HCV Ab (HCV Ab+). Multivariate logistic regression was performed.Figure 1. HCV Ab and HCV RNA positivity among people screened for HCV in the Dallas County Jail from 2015 to 2019 (N=14490).

Results: The prevalence of HCV Ab+ was 16.7% in the Dallas County Jail; 75.3% of those who tested HCV Ab+ were also HCV RNA+ (Figure 1). The HCV Ab+ incidence rate was 13.5 cases per 1000 person-years. People who were HCV Ab+ were more frequently (adjusted odds ratio [95% confidence interval], p-value): older (1.07 (1.06-1.07), p< 0.001), female (1.24 [1.07-1.44], p=0.004), white (2.12 [1.83-2.45], p< 0.001), and in the birth cohort 1945-65 (1.79 [1.44-2.23], p< 0.001; Table 1). In earlier birth cohorts (1940s), black men were more often HCV Ab+; in more recent birth cohorts (1990s), white and Hispanic females were more often HCV Ab+ (Figure 2). Among individuals who tested HCV Ab+, IDU was more frequently reported by white individuals, particularly women, compared to black individuals (p< 0.001; Figure 3).Table 1. Demographic predictors of Hepatitis C Antibody positivity among those undergoing routine blood draws from 2015-19 at the Dallas County Jail (AIC 7041; BIC 7048; df 10; p<0.001).

Figure 2. Trends of Hepatitis C Antibody prevalence and demographic prevalence ratios by birth year (prevalence ratio= proportion with disease/proportion with exposure) among people at the Dallas County Jail screened from 2017-2019 (N=10183). Demographic prevalence ratios were categorized by race (White, Hispanic, Black) and gender (Male, Female) into six categories. Gray bars represent the overall prevalence of HCV Ab+ by birth year.

Figure 3. The racial demographics of injection drug use by gender among those who tested HCV Ab positive at the Dallas County Jail in 2017-2018 (n=672; total population p<0.001; male p=0.004; female p=0.008).

Conclusion: The high prevalence and incidence of HCV at the Dallas County Jail argues for routine, universal testing and linkage to treatment. Additionally, demographic trends mirror the IDU epidemic and have valuable implications for risk reduction and treatment interventions.