Statewide Assessment of the Hepatitis C Virus Care Cascade for Incarcerated Persons in Vermont

Abstract

Objectives: Incarcerated persons in the United States have a high burden of hepatitis C virus (HCV) infection. This study assessed the impact of a statewide effort in Vermont to treat HCV in this group. Methods: We performed a retrospective, observational cohort study of all HCV-infected persons who were imprisoned in Vermont during the 19-month study period (December 2018–June 2020). The cascade of care comprised opt-out HCV screening, full access to direct-acting antiviral treatment (without hepatic fibrosis-based treatment restrictions), HCV specialist involvement, and medication-assisted treatment for patients with opioid use disorder. The primary outcome was sustained virologic response at 12 weeks after treatment completion (SVR12). Results: The study included 217 HCV-infected patients; the median age was 35 years (range, 18-73 years), 89% were male, 76% had opioid use disorder, 67% had a psychiatric comorbidity, and 9% had cirrhosis. Of the 217 patients, 98% had a liver fibrosis assessment, 59% started direct-acting antiviral treatment, 55% completed direct-acting antiviral treatment, and 51% achieved documented SVR12. Of the 129 HCV-infected persons who started direct-acting antiviral treatment, 92% completed therapy and 86% achieved documented SVR12. Psychiatric comorbidity was not significantly associated with achieving SVR12 (odds ratio = 0.67; 95% CI, 0.27-1.65; P = .38), nor was receiving medication-assisted treatment for patients with opioid use disorder (odds ratio = 1.45; 95% CI, 0.62-2.56; P = .45). Conclusions: This study reports the highest SVR12 rate achieved in a state incarcerated population to date. HCV treatment in incarcerated populations is a practical and efficacious strategy that should serve a foundational role in HCV elimination.

A Vermont Statewide Educational Intervention to Improve Access to Hepatitis C Virus Treatment in a Rural State

“…The curriculum consisted of four free and open-access online modules; (1) HCV basics, (2) screening for HCV, (3) care for patients who screen positive for HCV, and (4) linkage to care and HCV treatment basics. 20 The curriculum was designed for practicing healthcare professionals at the physician, nurse practitioner, physician assistant, and registered nurse levels to learn how to appropriately identify and move toward treatment patients with HCV, and was structured around the HCV guidelines. 10 The HCV basics module included information on the epidemiology, structure and pathogenesis, hepatopathic effects, and natural history and consequences of HCV and HCV infection.…”

“…We created a free, open-access, online curriculum pertaining to HCV care specifically in Vermont, which was then widely disseminated to PCPs. 20 We also traveled throughout the state and gave didactic sessions on HCV both in-person and remotely. We hypothesized that we would be able to show improved HCV knowledge among healthcare professionals throughout the state, and that this would increase HCV treatment across Vermont.…”

The hepatitis C care cascade in California state prisons: Screening and treatment scale-up and progress toward elimination, 2016–2023

“…There are limited data from carceral settings describing HCV treatment scale-up and outcomes in the direct-acting antiviral era. [1][2][3][4][5][6][7] This report examines HCV screening and the care cascade among California state prison residents who initiated treatment in the first year of program scale-up, including treatment completion, SVR, reinfection, and progress toward HCV microelimination.…”