25 September 2025
Welcome to the latest edition of our Webinar Wrap-Ups where we attend sector webinars and distil the most relevant insights for those working to improve the health of people who use drugs. This session explored how hepatitis C care can be strengthened in prisons and jails across the United States.
On Friday 12 September, INHSU hosted a Community of Practice webinar designed for those involved in hepatitis C care and management in the United States (US). While targeted at participants of the HCV Intervention Symposia Series, it was open to anyone working towards HCV elimination. The session was chaired by our Programs and Policy Manager Liv Dawson and featured:
- Karla Thornton, MD, MPH –Executive Director, Project ECHO®; Professor, Division of Infectious Diseases, University of New Mexico Health Sciences Center
- CAPT Chad A Garrett, MA, BSN, RN – Health Program Manager, Prisons Division, National Institute of Corrections
- Jean Schexnayder – Corrections Coordinator, Louisiana Office of Public Health STD/HIV/Hepatitis Program
Here, Liv shares her key takeaways from the event.
What was the core theme of the webinar?
Speaker Dr Karla Thornton set the scene, explaining how incarcerated populations have about a nine times higher prevalence of hepatitis C than the general population in the US. And almost 30% of all people with hep c in the US spend at least part of the year in a correctional facility.
This reinforced that prisons and jails are not just high-prevalence environments — they are key intervention points for hepatitis C elimination.
When correctional systems integrate screening, education, and treatment into routine practice, they can reduce transmission inside facilities and also stop transmission into community.
What gap, risk, or issue was highlighted that is often overlooked?
Despite the opportunity that carceral settings provide to drive elimination efforts forward, speakers pointed to persistent challenges that can undermine elimination efforts:
- Many incarcerated people still refuse treatment or follow-up labs, requiring repeated conversations and encouragement. This is often because, without peers and education, incarcerated individuals may not trust treatment or understand its benefits
- Short jail stays and fragmented systems make it easy for people to slip through the cracks. With so many people moving in and out of jails due to short stays, continuity of care is difficult without strong linkage systems in place
- Carceral staff often lack awareness of hepatitis C’s broader impact, meaning buy-in can be difficult without clear incentives
What ideas or innovations stood out that could change practice or thinking?
- Peer-led education (New Mexico): Dr Karla Thornton described a structured program where incarcerated individuals receive training to become peer educators, running workshops and supporting others to engage with HCV testing and treatment. The program is hugely successful. The peer educators have educated 37,903 of their peers to date about HCV.
- Engaging correctional staff (Federal system): CAPT Chad Garrett explained how framing HCV care in terms of operational benefits — reduced costs, smoother facility management, and reputational gains — has been effective in building staff support
- Parish jail screening (Louisiana): Jean Schexnayder outlined how partnerships between the Office of Public Health and local correctional facilities enable jail-wide screening and treatment, using mobile teams and clear pathways for continuity of care
What does this mean in practice for people working in the field?
Three lessons stood out:
- Use peers to build trust: Education delivered by people with lived experience is more credible and can shift attitudes faster than external messaging
- Speak to staff priorities: Correctional staff are more likely to support HCV initiatives when they see the operational advantages, not just the public health need
- Think population-level: Jail- or prison-wide approaches — rather than one-by-one opt-in testing — maximise reach and minimise missed opportunities
If there’s one thing to take forward from this webinar, what should it be?
That carceral settings must be treated as central to US hepatitis C elimination strategies. By combining peer leadership, staff engagement, and whole-population screening, prisons and jails can move from being barriers to becoming accelerators of elimination.
