The Impact of Medications for Opioid Use Disorder on Hepatitis C Incidence Among Incarcerated Persons: A Systematic Review

Changes in hepatitis C virus infections after implementation of an expanded treatment program in New Mexico state prisons

BACKGROUND

Numerous leading health organizations have developed plans to eliminate hepatitis C virus (HCV), but the success of these efforts can only be assessed through systematic monitoring of infections. People in prison are at very high risk for HCV infection and New Mexico (NM) prisons have one of the highest rates of HCV in the US For nearly two decades NM Corrections Department (NMCD) and Project ECHO® have been partnering to treat HCV in NM state prisons, including a significant expansion in treatment in 2020. Since the start of the treatment scale-up in 2020, 2981 people have been treated. Treatment expansion also allowed for the expanded data collection on HCV testing as people enter the prison system. The purpose of this analysis was to assess changes in HCV infections in state prisons after treatment expansion.

METHODS

From February 2021 to November 2024, ECHO received weekly reports on entrants coming into the prisons who tested positive for HCV antibody (Ab) and/or HCV RNA. Demographic and clinical details were only available for the entrants who are HCV RNA positive (viremic), so we were unable to adjust for demographics. Poisson regression was used to assess changes in the RNA positivity (HCV viremia) and Ab positivity among the total entrant population.

RESULTS

Of the 7689 entrants, 3917 (50.9 %) were Ab positive and 2456 (31.9 %) were viremic. HCV viremia among all entrants decreased significantly over time (Poisson rate ratio (RR): 0.9989, CI: 0.9981 - 0.9996, p = < 0.01). Ab positivity among all entrants did not change (Poisson RR: 1.0, CI: 0.9999 - 1.00, p = 0.08).

CONCLUSION

HCV viremia has decreased among entrants of NM state prisons, but Ab positivity has not changed. Other factors could be influencing the decrease in HCV viremia, including community treatment and shifting patterns in injection drug use, but it is likely that the expansion of treatment in carceral settings among high-risk populations is contributing to the decline in HCV viremia in prisons statewide. The collaboration between NMCD and Project ECHO may be contributing to decreasing HCV in state prisons.

Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions

Improving HIV and Hepatitis C Virus (HCV) management among people involved in the criminal justice (CJ) system who use drugs, in particular those with opioid use disorder (OUD), requires effective approaches to screening, linkage, and adherence to integrated prevention and treatment services across correctional and community agencies and providers. This manuscript reviews the literature to explore gaps in HIV, Hepatitis C, and OUD prevention, treatment, and delivery cascades of care for persons involved in the CJ system. Specifically, we compare two models of linkage to prevention and treatment services: Peer/Patient Navigation (PN) wherein the PN links CJ-involved individuals to community-based infectious disease (ID) and substance use prevention and treatment services, and Mobile Health Units (MHU) wherein individuals are linked to a MHU within their community that provides integrated ID and substance use prevention and treatment services. The most notable finding is a gap in the literature, with few to no comparisons of models linking individuals recently released from the CJ system to integrated HIV, Hepatitis C, and OUD prevention and treatment and other harm reduction services. Further, few published studies address the geographical distinctions that affect service implementation and their effects on these substance use, ID and harm reduction care cascades. This manuscript makes specific recommendations to fill this gap through a detailed evaluation of PN and MHU linkage models to co-located and integrated HIV, Hepatitis C, and OUD prevention and treatment services across different communities within the U.S.

Hepatitis C elimination among people incarcerated in prisons: challenges and recommendations for action within a health systems framework

Hepatitis C virus (HCV) is a global public health problem in correctional settings. The International Network on Health and Hepatitis in Substance Users-Prisons Network is a special interest group committed to advancing scientific knowledge exchange and advocacy for HCV prevention and care in correctional settings. In this Review, we highlight seven priority areas and best practices for improving HCV care in correctional settings: changing political will, ensuring access to HCV diagnosis and testing, promoting optimal models of HCV care and treatment, improving surveillance and monitoring of the HCV care cascade, reducing stigma and tackling the social determinants of health inequalities, implementing HCV prevention and harm reduction programmes, and advancing prison-based research.