Hepatitis C, Incarceration, and Drug Use: A Case for Resourcing Jail-Based HCV Treatment in the United States

While periods of incarceration may offer temporary stabilization for persons experiencing chaotic drug use and/or homelessness, the practice of treating HCV in jail settings remains relatively rare in the U.S., as incarcerated people lose their public benefits upon incarceration.

We undertook a needs assessment to identify gaps in HCV testing and treatment in the San Francisco county jails, and assess readiness for scaling up jail-based treatment. We analyzed quantitative data from jail medical records from 2016-2021 using multivariate logistic regression. We also conducted 31 qualitative interviews with people who were incarcerated, and 6 interviews with staff of Jail Health Services. 

From 2016-2021 there were 79 people known to be living with HCV while incarcerated who stayed in the jail long enough to be cured; having treated and cured these 79 people in jail could have averted an estimated 284 new infections. Those who primarily used heroin were 2.74 (95% CI: 2.08–3.62) times more likely to be HCV antibody positive than those who primarily used methamphetamine. 100% of interviewees reported recent substance use, with 87% reporting injection history and 91% being substance use treatment-experienced. 94% had been unhoused. 36% thought jail was the best place to be treated for HCV, with preferences for community-based treatment primarily based on which services they already utilized. Despite the advances Jail Health staff have made in optimizing care along the HCV care cascade, many expressed frustration about not having access to sufficient HCV medication to address need.

More than half of people cycling in and out of the jails and living with HCV in San Francisco remain untreated despite the long-standing existence of community treatment supports. Jail-based treatment is optimal for incarcerated people who use drugs chaotically in the community, as they are temporarily stabilized and supported to achieve cure.

Author: Shelley Facente, Katie Burk, David Leiva, A. Asa Clemenzi-Allen

Theme: Epidemiology & Public Health Research Year: 2023