Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Brief Communication Imprimir 

Páginas 225 a 227

Alert from the field: HCV Testing and Treatment for Adolescent and Incarcerated Populations

Alerta de campo: Test de HCV y Tratamiento para Adolescentes y Poblaciones Encarceladas

Alerta do campo: Teste de HCV e Tratamento para Adolescentes e Populações Encarceradas

Autores: G. Cajetan Luna

Executive Director of the Center for Justice for Health in Los Angeles, California.

G. Cajetan
Luna-Center for Health Justice
900 Avila Street, Suite 301
Los Angeles, California 90012

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How to cite this article

Keywords: Hepatitis C, HCV, adolescents, youth, injection drug use, homelessness, incarceration.
Palabra Clave: Hepatitis C, HCV, adolescentes, jóvenes, usuarios de drogas inyectables, sin-techo, encarcelados.
Descritores: Hepatite C, HCV, adolescentes, jovens, usuários de drogas injetáveis, sem-teto, encarcerados.

Despite recent advances in treatment for Hepatitis C Virus (HCV) infection, adolescents and incarcerated people are among two subpopulations in greatest need of treatment, yet generally lack access to HCV testing and face age-specific and institutional barriers to care. Exploratory research was conducted in 2016, including surveys among 125 incarcerated young men (18 to 24 years) living with HCV, followed by more in-depth life history interviews to identify attitudes, beliefs, and behaviors related to their HCV infections. The interviews indicated that the lack of early HCV intervention and treatment for adolescents and incarcerated youth significantly influences subsequent health care practices.

A pesar de los recientes avances en el tratamiento de la infección por el virus de la Hepatitis C (HCV), adolescentes y personas encarceladas están entre los dos subgrupos de poblaciones que más necesitan de tratamiento, pero raramente tienen acceso a los test de HCV y enfrentan barreras institucionales y etarias para su atención. Una pesquisa exploratoria fue realizada en 2016, que incluyó estudio con 125 hombres jóvenes y encarcelados (de 18 a 24 años) que tenían HCV, seguido de intensas entrevistas para identificar actitudes, convicciones y comportamientos relacionados a sus infecciones por HCV. Las entrevistas indicaron que la falta de intervención precoz en el tratamiento de HCV entre los adolescentes y jóvenes encarcelados influenció de manera importante las prácticas de salud subsecuentes.

Apesar dos recentes avanços no tratamento da infecção pelo vírus da Hepatite C (HCV), adolescentes e pessoas encarceradas estão entre os dois subgrupos de populações que mais precisam de tratamento, mas raramente têm acesso aos testes de HCV e enfrentam barreiras institucionais e etárias para seu atendimento. Uma pesquisa exploratória foi realizada em 2016, que incluiu estudo com 125 homens jovens e encarcerados (de 18 a 24 anos) que tinham HCV, seguido de intensas entrevistas para identificar atitudes, convicções e comportamentos relacionados às suas infecções por HCV. As entrevistas indicaram que a falta de intervenção precoce no tratamento da HCV entre os adolescentes e jovens encarcerados influenciou de maneira importante as práticas de saúde subsequentes.

Major advances have been made in recent years in the pharmacological treatment of Hepatitis C (HCV)1. People who have lived for decades with chronic HCV are now cured after 4 weeks of treatment. The success and efficacy of HCV treatment is very high (more than 95% in most cases), and varies according to genotype, disease severity, access and availability2. The cost and availability of treatment vary by country, region and even by city. Richer countries with secure privatized health systems have a higher cost of curative drugs3, while developing countries that do not have a comprehensive medical coverage can get the same drugs by a fraction of the price paid in rich countries4. However, approval for the use of these drugs and their availability varies from country to country. Even in the more developed countries with a national health system, certain subpopulations face challenges to obtain curative treatment. Adolescents and incarcerated persons are two subpopulations that are in severe need of treatment, often lack access to tests to prove HCV, and face institutional and age-related barriers to obtaining care5.

Teens are often considered the healthiest group at the height of their lives. For young people who have been deprived of their rights, poor, drug users or institutionalized, this feature is far from the truth. Homeless youth , street children, street children and girls, have a very high risk of contracting various infectious diseases, including HCV infection. The use of injecting drugs and the sharing of needles in piercings and tattoos are very common among this age group6,7. Young people between the ages of 13 and 19 are physically fit but have not yet developed their psychosexual appearance, are emotionally inexperienced, and may be going through the most challenging period of their lives, since physical changes and mental development are not in balance. Development-related adaptations need to be considered, new skills learned, and plans need to be made for the future. During youth, health beliefs and practices are established and will extend throughout adulthood8.Risks and risk behaviors can compromise health and well-being for the rest of their lives. Without adequate treatment, the diagnosis of a potentially debilitating disease during adolescence may compromise the individual's self-efficacy, future health practices, and well-being9. In 2016, an exploratory study was conducted including interviews with 125 incarcerated boys (ages 18-24) living with HCV, followed by further in-depth interviews about their lives, with a small sample to identify attitudes, beliefs and behaviors related to their HCV infections. Special attention was given to the barriers to HCV treatment and care in a prison context10. The original objective of this study was to develop a Strategic and Operational Plan for conducting broader tests to diagnose HCV. What became clear as a result of the interviews was that HCV testing and treatment is rare among incarcerated men, and the most important issue was not the development of a Strategic Plan, since the costs of broad treatment were often prohibitive, the subsequent medical care practices and self-efficacy perceived after the positive diagnosis. It is well known that incarcerated people are one of the high-risk population groups for HCV, the number of HCV infections in jails and prisons is higher than that of HIV. Sharing needles for tattoos and piercings, self-mutilations and incisions, and injecting drug use are common activities in the correctional context.

The provision of basic medical services and medical care is not readily available to all detainees and varies widely according to the institution11. The HCV test is not performed routinely only when high-risk activities or clinical symptoms are identified. The HCV test in incarcerated institutions inevitably leads to the identification of more cases, which may or may not lead to their treatment. Treatments initiated prior to incarceration may or may not continue, and treatment will almost never be initiated if the individual expects to be released within three months. The resources to provide HCV treatment in prison contexts vary widely, and the test can be performed, but treatment will not be done unless late-stage liver disease is identified.

Lack of intervention and early treatment for HCV in incarcerated adolescents and youth may influence the duration of subsequent medical practices. To test and identify a disease with a potential risk of death in adolescence and then not treat due to the high cost of treatment, or because it can "disappear naturally over time, or even because it is" very early "in the disease process , can give the imprisoned young man, without rights, a confused and dubious message. The message goes that their health is not important when compared to groups of other age groups or young people of higher classes, and / or that their health condition is not an immediate concern3. Proponents of adolescents with positive HCV diagnostic and young prisoners living with HCV should make moves in local, national and international levels to motivate policy makers to support a health agenda that provides care and treatment immediately adolescents with HCV12.


The study was funded by the Gilead Medical Sciences Initial Research.


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3. IMS Institute for Healthcare Informatics. (2016). Comparison of Hepatitis C Treatment Costs: Estimates of Net Prices and Usage in the US and Other Major Markets.

4. Gilead. (2015). Chronic Hepatitis C Treatment Expansion: Generic Manufacturing for Developing Countries.

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8. Lerner, R. M., Bowers, E. P., Geldhof, G. J., Gestsdóttir, S., & Desouza, L. (2012). Promoting positive youth development in the face of contextual changes and challenges: The roles of individual strengths and ecological assets. New Directions for Youth Development,2012(135), 119-128.

9. Kalmakis, K. A., & Chandler, G. E. (2015). Health consequences of adverse childhood experiences: A systematic review. Journal of the American Association of Nurse Practitioners,27(8), 457-465.

10. Luna, C. (2017, March 17). HCV Testing and Treatment for Incarcerated Adolescent and Young Adult Populations. Presentation at Academic & Health Policy Conference on Correctional Health, Atlanta, Georgia.

11. Beckman, A. (2016). New Hepatitis C Drugs Are Very Costly And Unavailable To Many State Prisoners. Health Affairs, 35(10), 1893-1901.

12. Luna, C. (2016, October 22-26). HCV Testing in Jails and Prisons. Presentation at National Conference on Correctional Health Care, Las Vegas, Nevada.
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