Hepatitis C treatment in a jail setting: A retrospective cohort analysis of low-barrier initiation of direct acting antivirals

• This is the first study to assess the feasibility of initiating HCV treatment in a U.S. pre-trial jail setting using a low-barrier approach, where patients received a full course of medication upon initiation. • Over half of individuals who initiated treatment in jail completed treatment before release, demonstrating feasibility even in a setting with unpredictable incarceration lengths. • Among those who obtained follow-up HCV RNA labs, cure rates for jail-initiated treatment were 85 %, comparable to those who initiated and completed treatment in prison. • Among individuals released from jail or prison with remaining HCV medications, 65 % ultimately obtained follow-up labs (with the majority of labs occurring during reincarceration events), identifying the need for post-release patient supports. A significant proportion of individuals with hepatitis C virus (HCV) experience incarceration. Jails house individuals who are pre-trial or for short sentences and represent a critical setting to expand HCV treatment access. Low-barrier treatment models may help overcome implementation barriers to initiating treatment in jail settings. In 2021, the Rhode Island Department of Corrections began implementing low-barrier HCV treatment including take-home medications for those released before completing therapy in both a jail (pre-trial) and prison (sentenced) setting. This study aimed to evaluate response to therapy for HCV infection between individuals who initiated treatment in jail versus those who initiated in prison. This study was an observational cohort of people receiving low-barrier HCV treatment initiation between January 2021 and September 2023 at the Rhode Island Department of Corrections. Logistic regression compared individuals who initiated therapy in jail to those initiating in prison. The primary outcome sustained virological response 12 weeks after treatment completion (SVR12). Of 160 individuals who initiated treatment during incarceration, 84 initiated in jail and 76 in prison. SVR12 was similar between individuals who initiated HCV treatment in jail (85%) and those who initiated in prison (86%). There was no statistical difference in likelihood of SVR12 between those initiating in a jail versus a prison in unadjusted bivariate analysis or an adjusted model. Individuals completing treatment in-facility were more likely to achieve SVR12. Jail-based HCV treatment initiation is feasible. However, individuals released with medication face challenges in linkage to care. Improved discharge planning and community linkage are critical to post-release treatment success.