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Clinical Trial
. 2019 Aug 8;19(1):703.
doi: 10.1186/s12879-019-4344-1.

Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial

Matthew J Akiyama  1   2 , Devin Columbus  3 , Ross MacDonald  4 , Alison O Jordan  4 , Jessie Schwartz  5 , Alain H Litwin  6   7   8 , Benjamin Eckhardt  3 , Ellie Carmody  3
Affiliations
Clinical Trial

Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial

Matthew J Akiyama et al. BMC Infect Dis. .

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 of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration.

Results: During the intervention, 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. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. 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.

Trial registration: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).

Keywords: HCV; Jail; Linkage to care; PWID; Prison.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow chart. HCV = hepatitis C virus, HIV = human immunodeficiency virus, VL = viral load, Tx = treatment
Fig. 2
Fig. 2
Hepatitis C virus (HCV) care cascade after incarceration in the New York City jails. In a cohort of 84 participants who returned to the community after incarceration, 26 (31%) linked to HCV care, 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Of the 9 participants with documented 12-week follow-up labs, this was a 78% SVR rate
Fig. 3
Fig. 3
Trajectories of people living with HCV after incarceration in the New York City Jails. Each row in an EventFlow figure represents one participant’s sequence of events during a period of time. The height of each bar is proportional to the number of records with that sequence, and its horizontal position is determined by the median time between events. Groups of sequences with the same preceding event are sorted by the number of records in each group. The sequence groups are shown from top to bottom in descending order of number of participants per group. For interval events such as returns to jail, the length of the intervals represents the mean duration of the grouped events. For point events such as linkage to HCV care, periods between the aggregated point events represent the mean length of time from any previous point event
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