Globally, hepatitis C virus (HCV) is among the highest priority diseases in custodial settings; however, the diagnosis remains suboptimal among people in custody. In resource-limited countries, inexpensive methods are needed to increase HCV case finding and linkage to care.

Between July and December 2018, in Gorgan central prison, residents and newly admitted inmates completed a short questionnaire, including data on history of HCV testing, drug use, injecting drug use, sharing injecting equipment, and imprisonment (newly admitted inmates only). All participants received rapid HCV antibody testing, followed by venepuncture for HCV RNA testing (antibody-positive only). Each enrollment questionnaire (yes/no) was compared with the results of the HCV antibody (positive/negative) and RNA testing (positive/negative).

Among 1,892 participants, 96% were male and 71% had ever used drugs. Overall, 72% had a history of drug use and 9% had a history of injecting drug use; 56% (91 of 163) had ever shared injecting equipment, respectively. Among newly admitted inmates, 69% had a history of imprisonment. The majority of participants (88%) had no history of HCV testing. Prevalence of HCV antibody was 6.7% (n=127), and HCV RNA was detected in 75% (87 of 116) of those who received venepuncture. Among all participants, history of drug use was the most accurate predictor of having positive HCV antibody and RNA tests (sensitivity: 95.2%, negative predictive value: 98.9%) and (sensitivity: 96.6%, negative predictive value: 99.5%), respectively. We found no combination of self-reported risk factors that would be reliable enough to skip the HCV RNA testing.

Screening for HCV infection based on the self-reported history of drug use could replace population-based screening to reduce costs. In resource-limited settings, developing tailored screening strategies is crucial for pursuing HCV elimination targets and further cost-effectiveness analysis is needed to confirm the optimal strategies.