CTNPT 034: HCV Screening in Prison Inmates

About The Study

This pilot study compared the acceptability of two hepatitis C virus (HCV) screening tests among short-term provincial prison inmates. Specifically, the study compared the proportion of study participants who, when offered, agreed to testing via fingerprick versus venipuncture (blood draw).

Background

Approximately 250,000 Canadians are currently living with HCV. The primary cause of HCV infection is injection drug use — some estimates suggest that up to 50 per cent of injection drug users have been exposed to HCV. A significant proportion of Canadian inmates report injection drug use and one in four have been previously exposed to HCV. In contrast, less than 1 per cent of the general Canadian population has been exposed to HCV; this means that the prison population is 40 times more likely to be exposed to HCV compared to the general population.

Despite this, less than 10% of provincial prison inmates in Quebec are screened for HCV screening during their incarceration, partly because testing must be voluntarily requested. As a result, incarcerated individuals are not screened systematically when they enter prison or based on their risk factors, such as injection drug use, unsafe tattooing, or body piercing practices. The current HCV testing standard in most Canadian prisons is using venipuncture (blood draw). However, this method requires a follow-up visit to receive results, meaning that short-term inmates may be released or transferred before their results are available.

An alternative HCV test is available via fingerprick. This test, though more expensive than venipuncture, provides results in 20 minutes, meaning it doesn’t require a second visit. The acceptability of HCV screening via fingerprick testing has been assessed in people who inject drugs but never in the prison population.

Study Approach

CTNPT 034 recruited 78 inmates with sentences between 2 and 12 weeks; inmates were approached within 24 hours of arrival to prison. Inmates who consented to participate in the study completed a baseline questionnaire about injection drug use and HCV. Participants were then asked if they would like to be screened for HCV and, if they consented, were randomized to receive either venipuncture or fingerprick testing. Those who refused screening completed a questionnaire about their perceptions of testing. Participants who underwent screening completed a questionnaire before and after to assess their perceptions and experiences with testing.

Acceptability was measured by the proportion of participants who agreed to be tested when offered one of the screening methods. The research team also compared the proportion of inmates screened via venipuncture versus fingerprick who received their test results before their prison release.

Results

While most participants (76 per cent) had used drugs in the past, only a minority (8 per cent) reported a history of injection drug use, and about half of all participants believed they were at a moderate or high risk of getting HCV. All inmates who were randomized to receive the fingerprick test accepted the test while only 87 per cent of those randomized to receive a venipuncture test accepted. Everyone who received the fingerprick test (100 per cent) was satisfied with it, compared to 97 per cent of those who received the venipuncture test. Similarly, 97 per cent of those tested with fingerprick would recommend it to others, while 94 per cent of those tested with venipuncture would do the same. Additionally, all those tested with fingerprick (100 per cent) would choose it again, while only 76 per cent of those tested with venipuncture would make the same choice.

Conclusion

Adult incarcerated men were more likely to accept fingerprick HCV screening than screening by a blood draw. They were also more likely to choose the fingerprick test for future HCV screening. Regardless of the test used, this research highlights the urgent need to move towards an opt-out screening approach for HCV elimination in prisons.