Comprehensive Understanding of Readiness for Elimination

Confidential

Comprehensive Understanding of Readiness for
Elimination of Hepatitis C in Corrections (Cure-HepC)

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Form Approved OMB No. 0920-XXXX Exp. Date xx/xx/20xx
Public reporting burden of this collection of information varies from 30 to 80 minutes with an estimated time to
complete of 55 minutes per response, including the time for reviewing instructions, searching existing
data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a currently valid OMB control number. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden
to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:
PRA (0920-XXXX).The goal of this survey is to understand practices surrounding hepatitis C virus screening, testing,
and treatment and the national burden of hepatitis C in carceral settings.Each responding system will receive a
request to complete this web-based survey with advance notification to allow time for record searches. Your survey
team will provide you with a unique system identifier that cannot be tied directly to the system answering this
survey.The survey has branching logic to improve efficiency and reduce the time burden for completing this survey.
Participating systems will have a set-time period, as determined by the survey team, to complete the survey. The
survey will be self-administered. If preferred, there will be an option to complete an interviewer-administered survey
via telephone or videoconferencing and this request should be made directly to the survey team.Please answer the
survey questions to the best of your ability. The information you provide will be reported in aggregate and only
released externally with your explicit permission. The analysis period for this survey is defined as the most recent
complete calendar year. Thank you!

Today's date

Unique system identifier

__________________________________

__________________________________
((Please only use unique identifier provided by
survey team))

The first set of questions are about your system during the analysis period.
1. During the analysis period, what was the
classification of your system?

State Prison System
Jail
Unified System (both state prison and jail within
a single administration)

2. During the analysis period, was your system under
court order or consent decree related to management of
patients with hepatitis C infection?

Yes, presently
No, presently
In the past, but not presently
Other

Other, please explain:
__________________________________________
3. During the analysis period, what was the total bed
capacity in your system?

__________________________________
((Please answer in whole numbers))

4. During the analysis period, what was the average
length of stay (in days) of the confined and/or
detained population in your system?

__________________________________
( (Please answer in whole numbers))

5. During the analysis period, what was the average
daily census of the confined and/or detained
population in your system?

__________________________________
( (Please answer in whole numbers))

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5a. During the analysis period, what was the average daily census of the confined and/or detained population in your
system by sex assigned at birth? (Please answer in whole numbers).

Males
______
Females ______
Other/Missing/Unknown
______

5b. During the analysis period, what was the average daily census of the confined and/or detained population in your
system by race/ethnicity? (Please answer in whole numbers).
American Indian or Alaska Native ______
Asian ______
Black or African American ______
Hispanic or Latino ______
Middle Eastern or North African ______
Native Hawaiian or Pacific Islander ______
White ______
Other/Missing/Unknown ______

5c. During the analysis period, what was the average daily census of the confined and/or detained population in your
system by age? (Please answer in whole numbers).
Less than 21 years old
______
21-29 years old
______
30-39 years old
______
40-49 years old
______
50-59 years old
______
60 years old and older
______

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6. The answer to the above questions were:

Estimated
Measured based on available data

The next set of questions are about hepatitis C virus (HCV) testing practices within your
system during the analysis period.
HCV screening consists of testing for the presence of antibodies to HCV, and if reactive,
testing for HCV RNA to diagnose current infection. 
Reflex testing means automatically performing HCV RNA testing on patients with a reactive
HCV antibody using the same blood sample. HCV screening may consist of single-step HCV
RNA testing for populations with high rates of recent HCV exposure. 
7. During the analysis period, what type of HCV
screening/testing was used by your system?

HCV antibody only
HCV antibody and HCV RNA testing
I do not know
Other

Other, please explain:
__________________________________________
7a. During the analysis period, was HCV antibody to
HCV RNA reflex testing performed by your system?

Yes
No
I do not know
Other
((Reflex testing means HCV RNA testing is performed
automatically on patients with a positive HCV
antibody using the same blood sample))

Other, please explain:
__________________________________________
8. During the analysis period, which HCV screening
methodologies did your system employ?
(Please select all that apply).

At intake or History and Physical exam: universal
screening, opt-out (performed unless patient
refuses)
At intake or History and Physical exam: universal
screening, opt-in (offered, performed if patient
agrees)
At intake or History and Physical exam: risk-based
testing per provider order
Annual or periodic testing for those at risk
Anytime testing per provider order
At discharge: universal screening, opt-out
(performed unless patient refuses)
At discharge: universal screening, opt-in
(offered, performed if patient agrees)
At discharge: risk-based testing per provider order
Other

Other, please explain:
__________________________________________

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The next set of questions are about hepatitis C virus (HCV) antibody and HCV RNA positivity
among intakes within your system during the analysis period.
9. During the analysis period, what was the total
number of intakes into your system?

10. During the analysis period, how many intakes were
tested for HCV antibody?

__________________________________
((Please answer in whole numbers))

__________________________________
((Please answer in whole numbers))

11. During the analysis period, among intakes tested
for HCV antibody, how many tested positive for HCV
antibody?

__________________________________
((Please answer in whole numbers))

12. During the analysis period, among intakes who
tested positive for HCV antibody, how many were tested
for HCV RNA?

__________________________________
((Please answer in whole numbers))

13. During the analysis period, among intakes tested
for HCV RNA, how many tested positive for HCV RNA?

__________________________________
( (Please answer in whole numbers) )

13a. During the analysis period, how many intakes tested positive for HCV RNA by sex assigned at birth?
(Please answer in whole numbers).

Males
______
Females ______
Other/Missing/Unknown
______

13b. During the analysis period, how many intakes tested positive for HCV RNA by race/ethnicity?
(Please answer in whole numbers).

American Indian or Alaska Native ______
Asian ______
Black or African American ______
Hispanic or Latino ______
Middle Eastern or North African ______
Native Hawaiian or Pacific Islander ______
White ______
Other/Missing/Unknown ______

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13c. During the analysis period, how many of intakes tested positive for HCV RNA by age?
(Please answer in whole numbers).

Less than 21 years old
______
21 - 29 years old
______
30 - 39 years old
______
40- 49 years old
______
50 - 59 years old
______
60 years old and older
______

14. The answer to the above questions were:

Estimated
Measured based on available data

The next set of question are about determining a hepatitis C virus (HCV) mid-year point
prevalance estimate among the total confined and/or detained population within your system.
For the following questions, you may enter values based on your best estimates. If you are
able to measure these values precisely, assess the HCV test results using data from people
residing in your system at the mid-year point (July 1) then use the most recent test results up
to the end of the analysis period (December 31). 
15. At the mid-year point, how many people were
confined and/or detained within your system?

16. Among those confined and/or detained at the
mid-year point, how many had been tested for HCV
antibody by the end of the analysis period?

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__________________________________
((Please answer in whole numbers))

__________________________________
((Please answer in whole numbers))

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17. Among those confined and/or detained at the
mid-year point who were tested for HCV antibody by the
end of the analysis period, how many tested positive
for HCV antibody?

__________________________________
((Please answer in whole numbers))

18. Among those confined and/or detained at the
mid-year point who had tested positive for HCV
antibody, how many were tested for HCV RNA by the end
of the analysis period?

__________________________________
((Please answer in whole numbers))

19. Among those confined and/or detained at the
mid-year point who were tested for HCV RNA by the end
of the analysis period, how many tested positive for
HCV RNA?

__________________________________
((Please answer in whole numbers) )

19a. At the mid-year point, how many of your confined and/or detained population tested positive for HCV RNA by
sex assigned at birth? (Please answer in whole numbers).

Males
______
Females ______
Other/Missing/Unknown
______

19b. At the mid-year point, how many of your confined and/or detained population tested positive for HCV RNA by
race/ethnicity? (Please answer in whole numbers).

American Indian or Alaska Native ______
Asian ______
Black or African American ______
Hispanic or Latino ______
Middle Eastern or North African ______
Native Hawaiian or Pacific Islander ______
White ______
Other/Missing/Unknown ______

19c. At the mid-year point, how many of your confined and/or detained population tested positive for HCV RNA by
age?  (Please answer in whole numbers). 

Less than 21 years old
______
21 - 29 years old
______
30 - 39 years old

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40- 49 years old
______
50 - 59 years old
______
60 years old and older
______

20. The answer to the above questions were:

Estimated
Measured based on available data

The next set of questions are about hepatitis C treatment practices within your system during
the analysis period. 
21. During the analysis period, what criteria was
utilized to select and prioritize your confined and/or
detained population who had hepatitis C infection for
treatment?
(Please select all that apply).

Length of stay
Blood tests (i.e., liver function test, APRI,
FIB-4)
Presence of co-existing illness
Liver imaging
Age
Participation in substance use treatment or
programming
Previous history of hepatitis C treatment
History of discipline and/or incidents during
current confinement
None, universal hepatitis C treatment policy
Other

Other, please explain:
__________________________________________
22. During the analysis period, how many unique
individuals did your system initiate treatment for
hepatitis C infection?
23. During the analysis period, which clinical
practice guideline(s) did you use to initiate
treatment for your confined and/or detained population
for hepatitis C infection?
(Please select all that apply).

__________________________________
((Please answer in whole numbers) )
American Association for the Study of Liver
Diseases (AASLD) HCV guidance
Federal Bureau of Prisons HCV clinical guidance
In-house developed HCV clinical guidance
Patient seen by outside specialist
Not applicable
Other

Other, please explain:
__________________________________________

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24. During the analysis period, did you offer
substance use disorder treatment to your confined
and/or detained population undergoing treatment for
hepatitis C infection?

Yes
No
Other

Other, please explain:
__________________________________________
25. During the analysis period, did you offer
medication for opioid use disorder (MOUD) to your
confined and/or detained population undergoing
treatment for hepatitis C infection who have an opioid
use disorder?

Yes
No
Other

Other, please explain:
__________________________________________

The next set of questions are about hepatitis C treatment opportunities and barriers within
your system.
26. Please identify challenges you have encountered in
your efforts to treat your confined and/or detained
population who have hepatitis C infection.
(Please select all that apply).

Medication cost
Medication access
Inadequate nursing staffing
Laboratory cost
Laboratory access
In-house provider access/adequacy
Specialist Provider access/adequacy
Patient non-compliance
Linkage to community providers on discharge
Access to medical services on discharge
No or Inadequate data systems
Length of stay
None of the above
Other

Other, please explain:
__________________________________________
27. What is your single greatest challenge in testing
and treating your confined and/or detained population
who have hepatitis C infection?

28. Is there anything else you would like to convey
regarding your ability to test and treat hepatitis C
infection among your confined and/or detained
population?

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__________________________________________
((Please thoroughly explain))

__________________________________________
((Please thoroughly explain))

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