When Assistant Professor of Medicine Anne Spaulding '84 became the first medical director for the Rhode Island Department of Corrections in 1996, she soon found shockingly high numbers of inmates suffering from a sometimes fatal disease. Often associated with illegal drug use, the hepatitis C virus, or HCV, can lead to cirrhosis, liver failure, and internal bleeding. Fortunately, HCV can be treated with the antiviral agents interferon and ribavirin, but the cost of treatment worries many prison officials. "It's not at all clear how often people with HCV suffer any symptoms at all," Spaulding says. "Some research shows that HCV-infected people can live their whole lives without ill effects, but I could show you studies that make the situation look much more deadly."

Working with a team of researchers from the Brown medical school and Miriam Hospital, Spaulding began a national effort to find out how many prisoners suffer from HCV. Their survey results, which appeared in the January issue of Preventive Medicine, covered 77 percent of all inmates in state prisons nationwide. Although 30 to 40 percent were infected with HCV, only Colorado claimed to screen routinely for the virus. Because of the disease's variable course, many states display no urgency in their approach to HCV. The researchers found that four state prison systems do treat HCV when it is diagnosed, while five more were developing a similar approach. But prison systems in at least seven states never treat the disease.

The results are troubling to Spaulding, whose position in Rhode Island's correctional system was court-ordered after a group of prisoners sued for better medical conditions. To address the situation, she and her colleagues have designed a model targeting HCV treatment for prisoners most likely to benefit from it.

Under the model, prisoners must meet three criteria: Their imprisonment must be for at least fifteen months so they can receive the complete treatment regimen; their bodies must respond well to the available treatments, which work only in some patients; and they must have consented to drug-abuse evaluation and treatment. The system, which is in place in Rhode Island, costs about $250,000 a year and could save many prisoners from disease and death. "A stay in prison," Spaulding says, "shouldn't put people under a death sentence."