Hepatitis C antibody and RNA tests for adults in provincial and federal correctional facilities in Ontario, Canada: a population-based study
BACKGROUND: Prevalence of Hepatitis C virus (HCV) has been shown to be high in correctional facilities. Testing for HCV begins with a blood test for antibodies followed by an HCV ribonucleic acid (RNA) test to establish active infection. Receiving the RNA test is a required step in the cascade of care for HCV management. PURPOSE: This thesis had two main objectives. The first was to determine an association between the facility of first testing positive for HCV antibodies and the time to receiving the RNA test. The facilities of interest were community medical facilities, provincial correctional institutions, and federal correctional institutions. The second objective sought to describe the number of duplicate antibody tests performed at Public Health Ontario Laboratories (PHOL). Once an individual tests positive for HCV antibodies, subsequent antibody tests are considered redundant. METHODS: Both objectives used a subset of PHOL data that included all HCV tests performed at PHOL from 1999-2014. A Cox’s proportional hazards model was used to determine an association between the facility of first antibody test and time to receiving the RNA test while controlling for other variables. The second objective counted the number of antibody tests performed at PHOL after an individual had demonstrated HCV positivity. RESULTS: Individuals who first tested HCV-positive in a provincial facility took longer to receive an RNA test when compared to those first tested in the community or federal prison; females were longer to receive the test when compared to males (hazard ratio [HR]=0.43; 95% confidence interval [CI]=0.37, 0.49 provincial vs. community for females in 2009-2014; HR=0.56; 95%CI=0.51, 0.62 provincial vs. community for males in 2009-2014).