34, 35 In 2006, the CDC discontinued its 25-year long surveillance system for acute HCV owing to low numbers of new symptomatic cases and a lack of resources to expand Midostaurin solubility dmso community-based testing sites.3 However, we have demonstrated that a real-life intervention targeted within correctional settings is feasible and has great potential for case identification among PWID, including asymptomatic individuals.36, 37 This streamlined questionnaire meets the mandate

to seek and find HCV within difficult-to-reach populations, voiced by the CDC and the Institute of Medicine.6, 10 Furthermore, although some studies suggest that the incidence of cases had declined through 2006,36 it has been difficult to fully capture trends among PWID due to their fragmented care. Moreover, new epidemics of HCV reported in young Caucasian drug initiates21, 29 likely render

the CDC’s estimate of acute infections as conservative. A jail or prison-based surveillance system may help to elucidate the true burden of new infections among PWID.3, 22 Our questionnaire enhanced the case-finding rate compared with a historical control period11 including the identification of asymptomatic patients, who are less likely to spontaneously Tamoxifen purchase clear viremia.38 Identification of such individuals is particularly important, since early treatment leads to high rates of sustained virologic clearance39 and may decrease the risk of transmission to others upon release to the community. We and others have previously demonstrated that antiviral treatment for acute HCV infection is feasible and as successful in the correctional setting as it is in the community.17, 40 Although treatment efficacy rates for chronic HCV genotype 1 infection are now

improved with the addition of specifically targeted antiviral agents,41 these Oxymatrine are at increased cost and toxicity compared with therapeutic interventions for acute infection.39 In addition to therapy, the structured environment of the prison system offers numerous opportunities for mental health assessments, HIV testing, and counseling regarding prevention, HAV and HBV immunizations, and harm reduction programs to decrease risk of reinfection.6, 30, 42 These interventions were well-received, with over 90% acceptance (data not shown). The age distribution of patients with self-reported HCV infection in our prison population is distinct from that seen in the 1998-2008 NHANES survey.20 Persons born from 1945 to 1965 accounted for over three-fourths of all HCV-infected patients living in the United States; males were twice as likely to be infected as females, and African Americans exhibited the highest seroprevalence rates.20 In stark contrast, 68% of inmates with self-reported HCV infection were born outside this time period.