11% of Hispanic inmates. Asian inmates had the highest percentage of chronic HBV infection (4.7%), and Hispanic inmates had the second highest percentage (3.6%). White inmates had the highest prevalence of HCV infection (24%). People who had previously been incarcerated had higher HCV prevalence in all age groups.

Correctional systems are constitutionally required to provide necessary health care to inmates that is consistent with the community standard of care. Screening of all incarcerated people for risk factors can identify those for whom blood tests for infection are indicated, and the high prevalence of HCV infection in prisons justifies such screening so that appropriate treatment can be provided to inmates whose blood tests are positive. Although screening, testing, and treatment could impose an economic burden (Spaulding et al., 2006), a number of correctional systems have successfully implemented medical management programs for viral hepatitis (Allen et al., 2003; Chew et al., 2009; Farley et al., 2005; Maru et al., 2008; Sabbatani et al., 2006; Sterling et al., 2004).

Hepatitis B vaccination in prisons is highly cost-effective; it was estimated in 2002 to cost $415 per HBV infection averted (Pisu et al., 2002). When made available, vaccinations in prisons have high uptake rates. Texas and Michigan inmate vaccination uptake rates have been reportedly been 60–80% (Vallabhaneni et al., 2004). Vallabhaneni et al. (2004) found that 93% of 153 male inmates who were asked said that they would agree to hepatitis B vaccination while incarcerated. Such prevention interventions save society money because they reduce postincarceration morbidity and mortality (Pisu et al., 2002). However, prison budgets have often not been sufficient to provide hepatitis B vaccinations, or other HBV and HCV services.

To capitalize on inmate readiness to participate in hepatitis prevention and control activities, correctional systems and public-health departments need to collaborate to provide targeted testing, appropriate standard-of-care medical management during incarceration, and followup medical services after release into the community. However, there are several barriers to such collaboration. Health departments and correctional facilities do not always exchange health information, and it can be difficult to track prisoners once they are released. State registries for hepatitis B and hepatitis C cases are needed so that incarcerated persons with these diseases can be quickly identified and properly managed once returned into local communities. The primary barrier to such collaboration is funding (McIntyre et al., 2008). Most correctional systems do not initiate treatment for chronic HCV infection unless an incarcerated person has sufficient time remaining on his or her sentence to complete treatment, which generally takes 6–12 months (Spaulding et al., 2006).

Obstacles to collaboration between correctional systems and government health institutions can be overcome. For example, in New York State,



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