Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 28;9(8):ofac350.
doi: 10.1093/ofid/ofac350. eCollection 2022 Aug.

Care Navigation Increases Initiation of Hepatitis C Treatment After Release From Prison in a Prospective Randomized Controlled Trial: The C-LINK Study

Timothy Papaluca  1 , Anne Craigie  1 , Lucy McDonald  1 , Amy Edwards  1 , Rebecca Winter  1 , Annabelle Hoang  1 , Alex Pappas  1 , Aoife Waldron  1 , Kelsey McCoy  1 , Mark Stoove  2 , Joseph Doyle  2 , Margaret Hellard  2 , Jacinta Holmes  1 , Michael MacIsaac  1 , Paul Desmond  1 , David Iser  1 , Alexander J Thompson  1
Affiliations

Care Navigation Increases Initiation of Hepatitis C Treatment After Release From Prison in a Prospective Randomized Controlled Trial: The C-LINK Study

Timothy Papaluca et al. Open Forum Infect Dis. .

Abstract

Background: Prison-based hepatitis C treatment is safe and effective; however, many individuals are released untreated due to time or resource constraints. On community re-entry, individuals face a number of immediate competing priorities, and in this context, linkage to hepatitis C care is low. Interventions targeted at improving healthcare continuity after prison release have yielded positive outcomes for other health diagnoses; however, data regarding hepatitis C transitional care are limited.

Methods: We conducted a prospective randomized controlled trial comparing a hepatitis C care navigator intervention with standard of care for individuals released from prison with untreated hepatitis C infection. The primary outcome was prescription of hepatitis C direct-acting antivirals (DAA) within 6 months of release.

Results: Forty-six participants were randomized. The median age was 36 years and 59% were male. Ninety percent (n = 36 of 40) had injected drugs within 6 months before incarceration. Twenty-two were randomized to care navigation and 24 were randomized to standard of care. Individuals randomized to the intervention were more likely to commence hepatitis C DAAs within 6 months of release (73%, n = 16 of 22 vs 33% n = 8 of 24, P < .01), and the median time between re-entry and DAA prescription was significantly shorter (21 days [interquartile range {IQR}, 11-42] vs 82 days [IQR, 44-99], P = .049).

Conclusions: Care navigation increased hepatitis C treatment uptake among untreated individuals released from prison. Public policy should support similar models of care to promote treatment in this high-risk population. Such an approach will help achieve hepatitis C elimination as a public health threat.

Keywords: DAA; elimination; hepatitis C; prison; transitional care.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. J. D. reports investigator-initiated research funding to institution from Gilead and AbbVie and honoraria to institution from Gilead. M. H. reports investigator-initiated research funding from Gilead Sciences and AbbVie. D. I. reports honoraria for speaking duties from AbbVie. A. J. T. reports the following: involvement in advisory boards for AbbVie, Gilead Sciences, Roche Diagnostics, BMS, Merck, Immunocore, Janssen, Assembly Biosciences, Arbutus, Vir Biotechnology, Eisai, Ipsen, and Bayer; honoraria for speaking duties from AbbVie, Gilead Sciences, Roche, and BMS; and investigator-initiated research funding from Gilead Sciences, BMS, AbbVie, and Roche Molecular Systems. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Time to direct-acting antivirals entry after community re-entry.
Figure 2.
Figure 2.
Participant consort diagram. *There was a higher likelihood of participants randomised to care navigation compared to standard of care would be prescribed hepatitis C treatment (n = 16/22, 73% vs n = 8/24, 33% p < 0.01).
Figure 3.
Figure 3.
Proportion of participants engaged in care at hepatitis C treatment milestones. DAA, direct-acting antiviral; SVR12, sustained virologic response 12 weeks after end of treatment.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization . Combating hepatitis B and C to reach elimination by 2030: advocacy brief. Available: https://apps.who.int/iris/handle/10665/206453. Accessed 3 July 2020.
    1. Scott N, McBryde ES, Thompson A, Doyle JS, Hellard ME. Treatment scale-up to achieve global HCV incidence and mortality elimination targets: a cost-effectiveness model. Gut 2017; 66:1507–15. - PubMed
    1. Degenhardt L, Peacock A, Colledge S, et al. . Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health 2017; 5:e1192–207. - PMC - PubMed
    1. Papaluca T, McDonald L, Craigie A, et al. . Outcomes of treatment for hepatitis C in prisoners using a nurse-led, statewide model of care. J Hepatol 2019; 70:839–46. - PubMed
    1. Palmer A, Papaluca T, Stoové M, et al. . A costing analysis of a state-wide, nurse-led hepatitis C treatment model in prison. Int J Drug Policy 2021; 94:103203. - PubMed