The high-risk classification was significantly more prevalent among Caucasians than their African American counterparts (OR, 16; 95% CI, 6.5-39.1). To determine if the racial distribution of cases was due to differential
application of the screening strategy, we ascertained race and ethnicity of 3,395 of 3,470 (97.8%) screened individuals (Table 1). African Americans constituted 32.0% of all male inmates screened, but only 0.6% of those were classified as high-risk. African CFTR modulator American females represented 9.6% of those screened, but only 2.3% of those classified as high-risk. Thirty of 35 patients with acute HCV infection stated that their high-risk behavior included sharing needles for the first time or sharing with a new partner, while five of 35 patients disclosed that they shared other drug paraphernalia (i.e., cookers, cotton), a known risk for
HCV transmission.19 Prior to implementation of the screening questionnaire, we identified 21 individuals check details with acute HCV infection over a 30-month period from multiple health care sites within the Massachusetts Department of Corrections; the average rate of identification of HCV infection by referral alone was 0.7 cases/month.11 In contrast, the current screening effort yielded 35 cases over an 18-month period from only two sites within this same institutional system; this average rate of 1.94 cases/month represented nearly a three-fold increase in our case-finding rate. Most importantly, acute cases identified through screening were twice as likely to be asymptomatic (48.6%) compared with those identified during the historical control period (33.3%; relative Methocarbamol risk, 2.0; P = 0.09).11 Inmates who self-reported a positive test for HCV were classified as having past infection, per the algorithm
described in Patients and Methods. We observed that similar racial/ethnicity trends noted for acute HCV infection also applied to a history of HCV. Whereas African Americans made up 23.0% of all inmates screened under 30 years of age, they only comprised 4.2% of those self-reporting past HCV infection; by contrast, non-Hispanic Caucasians made up 48.2% of inmates screened under 30 years of age, but comprised 78.2% of those with past infection. In Fig. 4, we report the distribution of self-reported HCV by age, stratified by sex (A) and race (B). Only the age distribution of the African American inmates resembled the expected shape from National Health and Nutritional Examination Survey (NHANES) data;20 in contrast, the age distribution of the other groups reflected the 2011 Massachusetts Department of Public Health (DPH) report showing an increase in confirmed HCV cases among Caucasians.21 The CDC estimates that approximately three-fourths of community patients living with chronic HCV in the United States were born within the birth cohort ranging from 1945 to 1965.20 However, within the prison population, only 31.9% of the inmates who reported past HCV infection were born within this birth cohort, whereas 67.