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."