Treating hepatitis C in jails seen as key to stopping spread
Study finds programs could halve new infections in those who inject drugs
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Offering jail-based hepatitis C programs that include testing, treatment, and post-release support could cut new hepatitis C virus (HCV) infections in half among people who inject drugs, according to data from a simulation study in the U.S.
Such programs may lower hepatitis C-related deaths by 40%, all at a cost well below standard healthcare benchmarks, the study found.
“Jail-based interventions lead to benefits among [people who inject drugs] both within and outside of jails … and providing treatment in jail is cost-saving compared to testing alone,” Lin Zhu, PhD, the study’s lead author and an assistant professor at the University of Miami Miller School of Medicine, said in a university news story.
The study, “Health Benefits, Costs, and Cost-Effectiveness of Jail-Based Hepatitis C Elimination Strategies,” was published in JAMA Internal Medicine.
Hepatitis C is caused by HCV, which is transmitted through contact with infected blood, most commonly through the sharing of needles among people who inject drugs. Without treatment, the infection can cause liver inflammation, or hepatitis, that may develop into cirrhosis (permanent scarring), liver failure, or liver cancer.
WHO aims for elimination
A class of medications known as direct-acting antivirals (DAAs) now offers a highly effective hepatitis treatment option, achieving a cure in the vast majority of cases. Given this progress, the World Health Organization has committed to eliminating hepatitis C as a significant global public health concern by 2030.
“The U.S. set a goal to reduce hepatitis C infections by 90% and deaths by 65% by 2030, but we’re not on track,” Zhu, who was a senior research engineer at Stanford University, in California, at the time of the study, said in a Stanford news story.
People who inject drugs are disproportionately affected by both substance use disorder and incarceration, with disorder rates running five times higher among justice-involved individuals than in the general population. And one in four people who inject drugs has reported incarceration or detention in the past year.
“Factors including lack of health insurance, housing instability, and criminalization and stigmatization of drug use create barriers to health care access and utilization among people who inject drugs, highlighting the need for innovative strategies to engage this group,” Zhu said.
Zhu’s team used a computer simulation model to predict how hepatitis C spreads among people who inject drugs, particularly those who cycle in and out of jail, and to test whether offering hepatitis C services in jails could make a meaningful difference over the long term.
The model was based on real-world data from the Philadelphia FIGHT program, which provides healthcare and support to people facing health disparities, and tracked simulated outcomes over 60 years following a 10-year implementation of jail-based interventions.
Comparing different approaches
The team compared four jail-based approaches against doing nothing. The first approach tested for HCV only at jail entry, while the second added navigation support to help people connect with and remain in care after release. The third paired HCV testing with DAA treatment while in jail, and the fourth combined all three: testing, treatment in jail, and support after release.
All simulated scenarios assumed that existing community-based programs remained in place, including hepatitis C testing and treatment, syringe service programs, and medication-assisted treatment for opioid use disorder.
The simulation modeled a group of 1,552 people who inject drugs, with a mean age of 32. Without any jail-based interventions, the model projected there would be 662 new infections and 240 HCV-related deaths per 1,000 people who inject drugs over 60 years.
The fourth, more comprehensive approach was the most effective. Compared with no jail-based intervention, this strategy reduced the total time people lived with infection by 35%, cut new infections by nearly half (47%), and lowered HCV-related deaths by 40%.
From a cost-effectiveness standpoint, the combined strategy performed exceptionally well. Its incremental cost-effectiveness ratio — a standard measure of the cost per unit of health gained — was about $11,000 per quality-adjusted life year (QALY). QALY is a measure of disease burden, including both the quality and the quantity of life lived.
This value was far below the commonly used U.S. cost-effectiveness benchmarks of $50,000 to $150,000 per QALY.
In fact, adding treatment in jail was found to be cost-saving relative to testing alone, and including navigation services consistently improved both health outcomes and economic value across all strategies tested.
The researchers noted some study limitations. They emphasized the fact that the simulations did not account for fixed startup costs or the full budgetary impact on jail systems, partly because of limited published data. The study also did not model transitions from jail to prison, which could affect how the virus spreads and whether people can maintain care.
“Despite restricted jail budgets, these programs for hepatitis C offer substantial health benefits and economic value when integrated into broader public health funding frameworks,” said Joshua Salomon, PhD, the study’s senior author and a professor of health policy at Stanford Medicine.
“Currently, few large jails have the capacity and funding to implement hepatitis C programs,” Salomon said. “If adequately resourced, extending these interventions to large and medium-sized jails could accelerate progress toward hepatitis C elimination.”
