Incarcerated populations originate from populations at high risk for bloodborne disease, including hepatitis C virus (HCV) and HIV. Our studies, and others, have shown that, over one-third of persons entering prisons in the State of California are infected with HCV. Indeed, HCV is acknowledged to have reached epidemic proportions among persons in correctional facilities: an estimated 1.4 million HCV infected persons pass through the correctional system each year in the United States. Many barriers, including ethical and organizational, inhibit systematically researching HCV disease and transmission risk in prison populations, and to date little data are available regarding transmission and clinical sequelae of HCV among inmates. Development of methods and strategies to study HCV within a cohort of parolees would address a significant gap in information on prison associated HCV, and be the foundation for future studies of HCV intervention, treatment and care for this highly-impacted population. Building on the relationship we have developed with the California Department of Corrections for entree, and the methods we have used to follow other high risk and hard-to-reach populations, we propose to recruit and enroll a cohort of parolees, and pilot the feasibility of enrolling, following and maintaining them in a longitudinal study of HCV transmission, persistence and treatment feasibility. This novel approach, of studying a prison population, outside of prison, will enable us to assess the impact of HCV in the prison population and potentially in the community, and to develop future research and HCV prevention schemes that could reduce the transmission and burden of HCV disease in the correctional environment and the communities from which it originates.
