Linkage to Hepatitis C Care Following Release from 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 to assess the rate and factors associated with linkage to HCV care after incarceration associated with a combined transitional care coordination (TCC) and patient navigation intervention. Results: During the intervention, n=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 (SD=12). Of those who returned to the community, 26 (31%) linked to HCV care within a mean of 29 days (SD=25); 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, and 7 (8%) had documentation of sustained virologic response. 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.