Treating hepatitis C virus infection in jails as an offset to declines in treatment activity in the community, New York City, NY, 2014-2020

IntroductionThere is scant data on implementation of large scale direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) in jails in the United States. New York City (NYC) Health + Hospitals/Correctional Health Services (CHS) aimed to scale up HCV treatment in the NYC jail system. This study describes the trends in annual HCV treatment in NYC jails compared to Medicaid-funded treatment in the NYC community from 2014-2020.MethodsIn this observational study, we extracted annual counts of DAA prescriptions for HCV for those (1) in the NYC community who were covered by Medicaid, and (2) those detained in NYC jails for 2014-2020. Data sources were NYC Department of Health and Mental Hygiene (DOHMH) annual reports and CHS treatment records, respectively. We used linear regression analysis to test for significant trends in annual treatment in these two cohorts during 2015-2019.ResultsFrom 2015-2019, treatments started in NYC jails increased annually (p=0.001), while Medicaid-funded prescriptions in the NYC community declined since a peak in 2015 (p<0.001). In 2019, NYC jail-based treatment initiations totaled the equivalent of 10% of treatment covered by Medicaid in NYC, up from 0.3% in 2015.ConclusionsScale up of jail-based HCV treatment is an important strategy to offset declines observed in the community. Addressing barriers to care in jail, such as improving testing, linkage to care, and affordability of DAAs for jail-based health services can help sustain high levels of treatment in US jails and other carceral facilities.