Access to Hepatitis C Treatment during and after Incarceration in New Jersey, United States: A Qualitative Study

Abstract

Despite effective antiviral therapy for hepatitis C virus (HCV), people who are incarcerated and those returning to the community face challenges in obtaining HCV treatment. We aimed to explore facilitators and barriers to HCV treatment during and after incarceration. From July–November 2020 and June–July 2021, we conducted 27 semi-structured interviews with residents who were formerly incarcerated in jail or prison. The interviews were audio-recorded and professionally transcribed. We used descriptive statistics to characterize the study sample and analyzed qualitative data thematically using an iterative process. Participants included five women and 22 men who self-identified as White (n = 14), Latinx (n = 8), and Black (n = 5). During incarceration, a key facilitator was having sufficient time to complete HCV treatment, and the corresponding barrier was delaying treatment initiation. After incarceration, a key facilitator was connecting with reentry programs (e.g., halfway house or rehabilitation program) that coordinated the treatment logistics and provided support with culturally sensitive staff. Barriers included a lack of insurance coverage and higher-ranking priorities (e.g., managing more immediate reentry challenges such as other comorbidities, employment, housing, and legal issues), low perceived risk of harm related to HCV, and active substance use. Incarceration and reentry pose distinct facilitators and challenges to accessing HCV treatment. These findings signal the need for interventions to improve engagement in HCV care both during and after incarceration to assist in closing the gap of untreated people living with HCV.

Treating Hepatitis C Virus Infection in Jails as an Offset to Declines in Treatment Activity in the Community, New York City, NY, 2014–2020

“… 5 To allow treatment of more patients, it is critical to alleviate barriers to accessing HCV treatment while in jail, such as delays in treatment initiation, and barriers after return to the community, such as lack of insurance coverage, competing priorities, and active substance use. 15 …”

“…Barriers to treatment may be different during and after incarceration, respectively, and each requires tailored solutions. 15 Further investment related to the proposal to eliminate HCV in the U.S. 3 should increase treatment in nontraditional healthcare settings, such as carceral facilities, substance use treatment centers, and homeless shelters. Among carceral health settings, jails are uniquely positioned to reach many persons among underserved populations living with HCV.…”