Essay Sample on Hepatitis C

Effects of Hepatitis C Education in a Correctional Setting

Hepatitis C is a liver disorder caused by the hepatitis C virus (HCV). Presence of HCV in the bloodstream can lead to severe liver dysfunctions and pathophysiology, including both acute and chronic forms of hepatitis. According to the World Health Organization (WHO), chronic HCV affects an estimated 71 million people worldwide (WHO, 2018). In the United States alone, around 3.9 million have HCV infection. There are two types of Hepatitis C infection: acute hepatitis C and chronic hepatitis C. Acute HCV infections are less serious, often are not associated with noticeable symptoms and are rarely associated with the emergence of life-threatening complications. Cases of acute HCV Infection usually resolve on their own within six months, most of the time even without any treatment (U.S. Food and Drug Administration, 2018). 60-80% of people with HCV will develop chronic HCV (WHO, 2019). Chronic HCV infection is more dangerous, as the risk for life-threatening complications such as liver cancer and liver cirrhosis rise significantly (15-30%) within 20 years (U.S. FDA, 2018). In some cases, HCV-positive individuals tend to avoid treatment because of their lack of knowledge and awareness about their condition, resulting in a scenario where there is a low take up of treatment for HCV infections. Some of the most significant support and education barriers among individuals with hepatitis C include psychological, emotional, and social difficulties that are associated with the condition. In terms of population group-related comparisons, the most affected region of the world are the European and Eastern Mediterranean regions, with a prevalence rate of 1.5% to 2.3%, respectively. An average prevalence rate of HCV infection in the other areas range from 0.5% to 1% of the population, depending on the country (WHO, 2018). Each country has specific factors unique to it and these include literacy level, aggressiveness of health promoters, and a general inclination to positive living and government commitment to having a healthy society by improving health equality.

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HCV is predominantly blood-borne. This means that it can only be transmitted to another person through blood-to-blood contact. What makes this issue so alarming is the fact that a significant number of those 71 million people who are already infected with HCV are going suffers from its long-term complications. According to data from the World Health Organization (2018), HCV leads to the death of around 399,000 people each year. The leading causes of hepatitis C related deaths include, but may not be limited to, cirrhosis of the liver and hepatocellular carcinoma. The problem with chronic HCV is that it is practically asymptomatic in the early stages. Patients with chronic HCV oftentimes only experience a few symptoms, however, once clinical decline occurs, it may be too late to reverse the liver damage. HCV is a medical condition that has proven to be especially challenging to diagnose and treat because a significant number of patients with HCV do not even have an idea that they are already infected.

The hepatitis C virus is considered to be a part of the Flavivirus family. The virus ribonucleic acid (RNA) is enveloped and is single-stranded. It is about 10,000 nucleotides in length (Ghany & Liang, 2016). The virus itself can only be transmitted through percutaneous blood exposure. In a typical hospital setting, for example, this can happen via unsafe injection practices and accidental needle sticks. Unsanitary and unhygienic hospital conditions may also increase the risk of HCV transmission. HCV may also be transmitted through sexual intercourse. Other examples of viral transmission pathways include, but may not be limited to, accidental blood contact, intranasal and intravenous drug use, and perinatal blood contact between the mother and her unborn child (WHO, 2018).

Signs and Symptoms

The signs and symptoms of HCV infection usually do not appear until after the incubation period. It is estimated that around 80% of individuals who have come in contact with the virus do not exhibit any of the well-established signs and symptoms of HCV infection (WHO, 2018). The signs and symptoms usually start to appear anywhere between the two weeks to six months after the infection. Acute HCV infection's signs and symptoms may include fatigue, fever, malaise, nausea, vomiting, abdominal pain and discomfort, dark urine, grey-colored feces, decreased appetite, joint pain, and yellowing of the skin and visible sclera (Germer, Mandrekar, Bendel, Mitchell, & Pao, 2011). The signs and symptoms change as the patient's HCV infection progresses. In patients with end-stage liver disease, for example, the signs and symptoms may include kidney failure, bleeding and bruising, formation of gallstones, buildup of fluid in the extremities and in the abdominal cavity (ascites), encephalopathy, muscle wasting, lack of concentration, itching of the skin, vomiting, bleeding of the throat and lower esophagus from varices, and unexplained weight loss Tso14(Pinter, Trauner, Radosavljevic, & Sieghart, 2016; Tsochatzis, Bosch, & Burroughs, 2014).

Screening and Diagnosis

According to the American Association for the Study of Liver Diseases (2018), one-time testing is recommended in the following patient groups: people born between 1945 and 1965 without prior ascertainment of risk, those with history of injecting drugs or using illicit drugs intranasally, those on long-term hemodialysis, those with prior percutaneous/parenteral exposures in an unregulated setting, healthcare and public safety workers after needle stick, sharps or mucosal exposures to HCV-infected blood, children born to HCV-infected women, those who received a clotting factor or blood transfusion, or those who underwent an organ transplant before 1987-1992. In addition, those who have been incarcerated, those With Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome (HIV/AIDS) infection, sexually active people about to start pre-exposure prophylaxis for HIV, those with unexplained chronic liver disease and/or chronic hepatitis, and solid organ donors.

In diagnosing infection and to initially screen high-risk groups, HCV antibody test serum is ordered to see if they have been exposed to the hepatitis C virus. Once positive on HCV antibody test, an HCV antigen or Nucleic Acid Amplification Test (NAT) is used to confirm positivity (Centers for Disease Control and Prevention, 2016). Liver biopsy is not used to diagnose hepatitis C infection but is useful in staging fibrosis and the degree of hepatic inflammation. In the US, liver elastography is approved and, along with serum tests of fibrosis, has mainly avoided the need for a liver biopsy (American Association for the Study of Liver Diseases, 2018).

HCV Treatment

A wide range of pharmacological therapies for chronic HCV has been developed over the past decade. Anti-viral medications, for example, have proven to be an effective intervention, capable of curing more than 95% of hepatitis C infections (WHO, 2018). Their discovery and availability lead to a significant reduction in the number of deaths caused by HCV infection. There are, however, two problems that remain. First, the HCV infection and mortality rates remain stubbornly high despite ongoing efforts to lower them. Second, access to diagnostic and treatment services remains low, negating the supposedly positive effects of the discovery and availability of antiviral drugs. Arguably the most severe problem associated with HCV infection is that a vaccine has yet to be developed and/or discovered. It is important to note, however, that the academic, medical, and research communities are all working together to expedite the development and or discovery of a vaccine.

HCV in the Incarcerated Population

Even though HCV infections are common among prisoners. HCV infections are common among prisoners. According to Larney et al (2013), the regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k=1) and Australasia (35%; 95% CI: 28%, 43%; k=9). It is estimated that there were 1.75 million new HCV infections in 2015 (globally, 23.7 new HCV infections per 100 000 people) and new HCV infections in prisons exceeds 30 per 100 persons per year (Zampino et al., 2015). Such prevalence rates require the adoption of new strategies for educating the incarcerated to reduce the number of HCV infections. In the United States, 93.3% of people are incarcerated are male in comparison to 6.7% for females (Loesche, 2017). Rhodes et al (2008) identified that the rates of HCV infection among incarcerated adult males across jails, substance abuse treatment centers, and prisons average 27% to 29.7% which translates in a higher population of an incarcerated male with HCV necessitating the inmates' education program.

Health Literacy Among Adult Incarcerated Males

The incarcerated population has a low level of literacy. According to Harlow (2019), "30% of the people who are incarcerated have attained less than a high school diploma". However, 14% of the general population has not completed high school (Tofig, 2017). Tofig (2017) reported that the incarcerated have lower proficiency because almost half of have not earned their high school diploma, much less post-secondary education. Tofig (2017) found that the incarcerated adult population also scored poorly in their literacy and numeracy levels. In the literacy test, 29% of the incarcerated population scored lower than level 2 while only 19% of the general population scored lower than Level 2. For the numeracy test, 52% of the adults that are incarce...