Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial

Abstract

Background Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant’s existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant’s wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. Trial registration Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).

Continuum of Hepatitis C Care Cascade in Prison and Following Release in the Direct-acting Antivirals Era

“…These ndings highlight the signi cant impact of prison release on treatment response assessment and its interpretations. The ITT SVR among former inmates who initiated treatment in community was similar to a recent study from New York City jails (45% vs. 41%); however, mITT SVR in our study was higher compared to their observed cure rates for community initiates (100% vs. 78%) (15). These ndings may suggest a lower risk of reinfection or treatment failure in the Iranian community compared to the United States.…”

“…There is a growing body of evidence on successful transitional programs to engage patients with healthcare services after release -mainly conducted by community-based providers and NGOs-ranging from reminder calls to intensive case management (36). Three studies from the United States have reported that only one-quarter of patients who returned to the community were linked to HCV care after incarceration (15,37,38). However, we showed that more than two-thirds of patients could be linked to care following release, highlighting the critical role of active patient navigation in engaging patients with post-release care.…”

“…Community-based organizations and NGOs can play an invaluable role in the community reintegration of offenders (19). To date, studies on linkage to care from incarceration have been mainly focused on people with HIV infection, and a variety of strategies, including case management and patient navigation, have been introduced to facilitate the transition period for these patients (15,20). Although developing effective care models require knowledge on the gaps in continuity of care and potential solutions (11), evidence lack around feasibility and e ciency of such interventions among HCV patients (21,22).…”

Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care

“…Simplified treatment algorithms [ 41 ] along with expanded eligibility criteria for 8-week treatment regimens [ 42 ] should be leveraged when clinically appropriate to allow more individuals to be treated in jail with shorter stays. Patient navigation strategies that have demonstrated early effectiveness in our setting [ 9 ] should be further evaluated and scaled up to improve treatment outcomes when patients are discharged from jail.…”

“…Challenges to HCV treatment in jails include short and unpredictable lengths of stay (median 19 days for admissions to NYC jails during 2018) [ 8 ] and low rates of linkage to community care after discharge (range, 9%–31%) [ 9 , 10 ]. Treatment in prisons has scaled up in a number of states, but gaps remain (range, 0.1%–28.4% of HCV-infected persons treated per year) [ 11 ].…”