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

Abstract

Background The population detained in the New York City (NYC) jail system bears a high burden of hepatitis C virus (HCV) infection. Challenges to scaling up treatment include short and unpredictable lengths of stay. We report on the clinical outcomes of direct-acting antiviral (DAA) treatment delivered by NYC Health + Hospitals / Correctional Health Services (CHS) in NYC jails from 2014-2017. Methods We performed a retrospective observational cohort study of HCV patients with detectable HCV RNA treated with DAA therapy while in NYC jails. Some patients initiated treatment in jail while others initiated treatment in the community and were later incarcerated. Our primary outcome was sustained virologic response at 12 weeks (SVR12). Results There were 269 patients included in our cohort, with 181 (67%) initiating treatment in jail and 88 (33%) continuing treatment started in the community. SVR12 virologic outcome data was available for 195 (72%) individuals. Of these, 172 (88%) achieved SVR12. Patients who completed treatment in jail were more likely to achieve SVR12 relative to those who were released on treatment (adjusted risk ratio 2.93, 95% CI 1.35, 6.34). Of those who achieved SVR12, 114 (66%) had a subsequent viral load checked. We detected recurrent viremia in 18 (16%) of these individuals, which corresponded to 10.6 cases per 100 person-years of follow-up. Conclusions HCV treatment with DAA therapy is effective in a jail environment. Future work should address challenges related to discharging patients while they are on treatment, loss to follow-up, and a high incidence of probable reinfection.

Innovations in Hepatitis C Screening and Treatment

“…(63) There have also been increased models of patients being treated on site in correctional facilities. (64,65) Telemedicine has emerged as an promising model of HCV treatment in prisons, obviating challenges associated with transporting prisoners to off-site clinics. (66) Efficacy of telemedicine in HCV treatment was demonstrated beginning during the pre-DAA era through Project ECHO (Extension for Community Healthcare Outcomes; discussed subsequently) and when the Virginia Department of Corrections partnered with an academic medical center to treat 59 inmates.…”

The risk of hepatitis C virus recurrence in hepatitis C virus‐infected patients treated with direct‐acting antivirals after achieving a sustained virological response: A comprehensive analysis

“…Nineteen studies were identified assessing recurrence in high‐risk patients who achieved SVR following DAAs therapy 14,15,21,27‐29,45‐57 . The median follow‐up time post‐SVR was 17 months (interquartile range, 9‐21).…”

“…14,15,21,[27][28][29][45][46][47][48][49][50][51][52][53][54][55][56][57] The median follow-up time post-SVR was 17 months (interquartile range, 9-21). Of those studies, four evaluated the risk in prisoners, 15,49,53,56 S2).…”

Hepatitis C Virus Is Associated With Increased Mortality Among Incarcerated Hospitalized Persons in Massachusetts

“…Although prisons have rolled out more comprehensive HCV treatment programs, coordination of HCV treatment in jails is problematic as detained people often have short or uncertain periods of detainment. There is increasing evidence that people who are in jail can be successfully treated with HCV medications, even when they are discharged mid–treatment course [ 24 ].…”