Abstract
Hepatitis C virus (HCV) continues to be a major public health issue in the United States, even though there are effective curative antiviral treatments. In 2023, Florida had one of the highest rates of acute HCV in the country, showing the need for focused local action. In Orange County, this is especially important. Hispanic and Latino residents make up 33.8% of the population, so outreach that is both culturally and linguistically appropriate is a priority for health equity. The county also has a large jail system, with 35,315 bookings and an average daily population of 2,378 in 2024. This setting offers a key opportunity for HCV screening, diagnosis, treatment initiation, and connecting people to care after release. People in correctional facilities have much higher rates of HCV than the public. Research supports universal opt-out screening in jails and prisons as a key step toward eliminating HCV. Orange County Corrections Health Services already provides intake screening, free HCV testing, access to medication, and follow-up planning after release. This makes the Orange County Jail an important place for intervention. For nurse leaders and advanced practice nurses, improving the HCV care process here is a practical, equity-focused approach. It can help prevent liver disease and improve ongoing care for vulnerable groups.
Keywords: hepatitis C, Latino health, correctional health, Orange County, Florida, health equity
Hepatitis C Burden in Orange County, Florida: Implications for the Latino Community and the Orange County Jail
Hepatitis C virus (HCV) is still one of the most serious bloodborne infections in the United States. It can lead to chronic liver disease, cirrhosis, liver cancer, and deaths that could be prevented. Although curative direct-acting antiviral therapy has transformed HCV treatment, substantial gaps persist in diagnosis, access to therapy, and continuity of care, especially among populations affected by incarceration, language barriers, unstable insurance coverage, and fragmented access to healthcare. The Centers for Disease Control and Prevention (CDC, 2025a) reported 4,966 acute HCV cases nationwide in 2023. After accounting for cases that may have been missed, this estimate is about 69,000 acute infections. That same year, there were 101,525 new chronic HCV cases and 11,194 deaths related to hepatitis C. These numbers show that HCV remains a major public health problem, even though there are very effective treatments available.
Florida stands out in the current HCV situation. In 2023, the state had the second-highest rate of acute hepatitis C in the country at 6.3 cases per 100,000 people, just behind West Virginia (CDC, 2025b). This rate is much higher than the national average, indicating that the risk of new infections remains high. Because of this, Florida needs stronger public health efforts to quickly identify people at risk and help them get treatment.
In Orange County, it is important to view HCV as both a public health and a health equity issue. Hispanic and Latino residents make up 33.8% of the county’s population (U.S. Census Bureau, 2025), so screening, education, and treatment must be culturally and linguistically appropriate. It is important to note that being Latino is not a biological risk factor for HCV. Instead, differences in health outcomes are mostly due to social and structural factors, such as language barriers, unstable insurance coverage, transportation barriers, limited access to primary care, and challenges obtaining specialty referrals. According to the CDC, even among people with insurance, only about one in three receive timely treatment for hepatitis C, with rates being even lower for those on Medicaid. The lack of a single public report compiling county-level HCV cases also makes it difficult to get an accurate picture of the situation in Orange County. Still, state and correctional health data show that the local burden is significant. Orange County has a large jail system, with 35,315 bookings in 2024 and an average daily population of 2,378 (Orange County Jail Oversight Commission, 2025a). These numbers indicate that the jail is a major point of healthcare contact for many people each year, many of whom may not have steady access to preventive healthcare outside of jail.
This makes the Orange County Jail a key place for public health action. Orange County Corrections Health Services provides medical and mental health care around the clock, operates five medical clinics, and screens every person upon arrival. According to the Orange County Jail Oversight Commission, the jail offers HCV testing at no cost, makes medications available through an external provider, and has procedures in place for follow-up care after release. This indicates that the county already has a foundational system for hepatitis C care that can be further developed, rather than creating a new program from the ground up.
This correctional setting matters since people in jail have much higher rates of HCV than the general population. McNamara et al. (2024) found that people in U.S. jails and prisons have HCV rates about 10 times higher than others. The authors said that eliminating HCV is not possible without including jails and prisons in the effort. They recommend universal opt-out HCV screening when people enter jail, since only screening based on risk can miss many cases. In Orange County, with over 35,000 bookings each year, the jail is a major place to find cases, start treatment, and plan for care after release.
For Orange County’s Latino community, the jail setting brings both challenges and opportunities. The challenge is that being in jail can make it even harder to get healthcare. The opportunity is that screening in jail can find people who might not otherwise be diagnosed and help them get treatment before serious liver disease develops. But diagnosis alone is not enough. A good HCV program should use qualified medical interpreters, provide education materials in Spanish, provide clear discharge instructions, and arrange formal referrals to trusted community clinics after release. Without these steps, people may not get the care they need, even if they are diagnosed by medical providers. This issue represents a practical population health and system-level quality improvement opportunity. The most effective next step is to strengthen the HCV care cascade in the Orange County Jail by reinforcing universal opt-out screening at intake, standardized confirmatory testing, culturally responsive patient education, and structured post-release linkage to care. Nurse leaders are uniquely positioned to monitor key performance indicators, including screening completion, confirmatory RNA testing, treatment initiation prior to release, and successful linkage to community care within 30 days. A culturally responsive correctional HCV model can improve health equity, reduce preventable liver-related morbidity, and align Orange County practice with broader HCV elimination goals.
In summary, hepatitis C is still a major public health issue in Florida. Orange County it deserves special focus due to its large Latino community and busy jail system. Efforts aimed at the Latino population should focus on health equity, access, and culturally appropriate care, rather than treating ethnicity as a risk factor. The Orange County Jail is a practical and important place for HCV screening, starting treatment, and connecting people to care after release. For nurse leaders, APRNs, and correctional health teams, this is a timely opportunity to improve infectious disease prevention and reduce long-term problems from hepatitis C in a vulnerable community.
References
Centers for Disease Control and Prevention. (2024). Health disparities in Hispanic or Latino people. U.S. Department of Health and Human Services. https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/populations/hispanic-latino.html
Centers for Disease Control and Prevention. (2025). viral hepatitis surveillance report. U.S. Department of Health and Human Services. https://www.cdc.gov/hepatitis-surveillance-2023/about/index.html
Centers for Disease Control and Prevention. (2025b, April 15). Table 3.1 – Acute hepatitis C: Number and rates of cases. In 2023 viral hepatitis surveillance report. U.S. Department of Health and Human Services. https://www.cdc.gov/hepatitis-surveillance-2023/hepatitis-c/table-3-1.html
McNamara, M., Martin, N. K., Barocas, J. A., Akiyama, M. J., Eckhardt, B. J., & Springer, S. A. (2024). Advancing hepatitis C elimination through opt-out universal HCV screening and treatment in incarcerated populations. Emerging Infectious Diseases, 30(13 Suppl), S194–S200. https://doi.org/10.3201/eid3013.230859
Orange County Jail Oversight Commission. (2025). Orange County jail’s status [Presentation slides]. Orange County Government. https://www.ocfl.net/Portals/0/Library/Jail-Judicial/docs//LinkClick.aspx?fileticket=A5cpmJ9vNuU%3D&portalid=0
Orange County Jail Oversight Commission. (2025). Corrections Health Services [Presentation slides]. Orange County Government. https://www.ocfl.net/Portals/0/Library/Jail-Judicial/docs/FINAL%20Orange%20County%20Jail%20Oversight%20Commission%20PPT.pdf
U.S. Census Bureau. (2025). QuickFacts: Orange County, Florida. https://www.census.gov/quickfacts/orangecountyflorida
populations. The minority health ad health disparities research and education act, 13(21).
Dr. Edwin Montanez, DNP, MBA, APRN NP-C, Professor Nursing Program AGMU