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. 2020 Oct 5:27:100567.
doi: 10.1016/j.eclinm.2020.100567. eCollection 2020 Oct.

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

Justin Chan  1 , Fatos Kaba  1 , Jessie Schwartz  2 , Angelica Bocour  2 , Matthew J Akiyama  3 , Zachary Rosner  1 , Ann Winters  2 , Patricia Yang  1 , Ross MacDonald  1
Affiliations

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

Justin Chan et al. EClinicalMedicine. .

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.

Keywords: Care cascade; Direct-acting antiviral; Hepatitis C virus; Incarcerated; Jail.

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Conflict of interest statement

The authors of this study have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Hepatitis C virus (HCV) cascades of care for patients incarcerated during January 1, 2014–December 31, 2017 a) overall, b) long stay, c) and frequent stay. NOTE: Percentages are calculated using the previous step as the denominator, unless otherwise indicated.
Fig. 1
Fig. 1
Hepatitis C virus (HCV) cascades of care for patients incarcerated during January 1, 2014–December 31, 2017 a) overall, b) long stay, c) and frequent stay. NOTE: Percentages are calculated using the previous step as the denominator, unless otherwise indicated.
Fig. 1
Fig. 1
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