The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014–2017

Abstract

Background High patient turnover presents challenges and opportunity to provide hepatitis C virus (HCV) care in US jails (remand facilities). This study describes the HCV care cascade in the New York City (NYC) jail system during the direct-acting antiviral (DAA) treatment era. Methods Patients admitted to the NYC jail system from January 2014 through December 2017 were included in this retrospective cohort analysis. We describe rates of screening, diagnosis, linkage to jail-based care, and treatment among the overall cohort, and among subgroups with long jail stays (≥120 days) or frequent stays (≥10 admissions). The study protocol was approved by a third-party institutional review board (BRANY, Lake Success, NY). Findings Among the 121,371 patients in our analysis, HCV screening was performed in 40,219 (33%), 4665 (12%) of whom were viremic, 1813 (39%) seen by an HCV clinician in jail, and 248 (5% of viremic patients) started on treatment in jail. Having a long stay (adjusted risk ratio [aRR] 8·11, 95% confidence interval [CI] 6·98, 9·42) or frequent stays (aRR 1·51, 95% CI 1·04, 2·18) were significantly associated with being seen by an HCV clinician. Patients with long stays had a higher rate of treatment (14% of viremic patients). Sustained virologic response at 12 weeks was achieved in 147/164 (90%) of patients with available virologic data. Interpretation Jail health systems can reach large numbers of HCV-infected individuals. The high burden of HCV argues for universal screening in jail settings. Length of stay was strongly associated with being seen by an HCV clinician in jail. Treatment is feasible among those with longer lengths of stay. Funding None.

The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients

“…Prior studies showed that treatment interruption as a result of early release or transfer can negatively impact the SVR rates among the incarcerated cohort [ 14 ]. While high SVR beyond 90% is widely reported among incarcerated-HCV patients remained in follow-up, SVR by intention to treat was significantly lower, ranging between 37–72% [ 18 , 20 , 22 - 24 ]. The difference is even more apparent among a larger cohort with high proportion of subjects being lost to follow-up [ 18 , 23 , 24 ].…”

“…While high SVR beyond 90% is widely reported among incarcerated-HCV patients remained in follow-up, SVR by intention to treat was significantly lower, ranging between 37–72% [ 18 , 20 , 22 - 24 ]. The difference is even more apparent among a larger cohort with high proportion of subjects being lost to follow-up [ 18 , 23 , 24 ]. In this study, we successfully maintained a high retention rate in this large incarcerated cohort by ensuring adequate treatment duration, thus avoiding unplanned treatment interruption leading to treatment default.…”

“…Despite international guidelines recommending unrestricted treatment for all HCV patients regardless of their incarceration status, DAA rationing is still common in many parts of the world due to financial and ethical concerns [ 23 , 24 , 34 ]. Unrestricted HCV treatment represents a cost-effective strategy in the long run.…”

“…Despite the emerging DAA data among the incarcerated-HCV cohort, the DAA treatment outcomes from Asia, particularly South East Asia region, remained limited [ 18 - 24 ]. As incarcerated HCV patients were generally excluded from clinical trial, real-world treatment outcome is valuable to strategize micro-elimination among the incarcerated population.…”

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

“…In more recent data from the DAA era, in the New York City jail system during 2014-2017, of 269 patients with HCV infection who started DAA treatment, 172 (64%) achieved documented SVR12, although there was a 16% subsequent reinfection rate, and the population-level SVR12 among all incarcerated HCV-infected patients was 3.2%. 19,20 International data on treatment of HCV infection among incarcerated persons are sparse, although 1 study assessed the HCV care cascade in prisons in Quebec, Canada, during 2017-2018 and found that 2 of 16 incarcerated HCV-infected patients achieved SVR12. 21 A more recent study from Taiwan with opt-in screening found that of 276 people in jail identified as having positive HCV serology (HCV exposure), 191 (69%) had HCV infection and 165 (60%) achieved SVR12 with DAA treatment.…”