Hepatitis C Testing Protocols Across Massachusetts Jails, 2022-2023: An Opportunity for Intervention

Hepatitis C virus (HCV), the most common blood-borne infection in the United States and a leading cause of liver disease, disproportionately affects populations who are incarcerated. Despite the prevalence of HCV infection among people involved in the criminal legal system, HCV testing and treatment policies are not yet standardized. Our study sought to examine the differences in HCV testing and treatment protocols across Massachusetts county jails.

In this cross-sectional study, we examined the HCV testing and treatment protocols of the 14 county jails in Massachusetts from November 2022 through February 2023.

Of the 12 jails that responded to requests for information, 10 jails used opt-in testing, 1 jail used opt-out testing, and 1 jail had no testing protocol. All 12 jails explicitly inquired about HCV history at intake, but only 3 jails inquired about current HCV treatment. For the 5 jails that had treatment initiation policies, all had barriers to treatment, including mandatory length-of-stay or sobriety requirements.

Findings from this study underscore the need for policy changes that require adoption of universal opt-out HCV testing across county jails and standardized HCV treatment protocols, with a focus on linkage to outpatient care and treatment of substance use disorder. This approach can address HCV in populations who are incarcerated and can help mitigate health disparities between incarcerated people and the general public.