A Mixed-Methods Assessment of Hepatitis C Treatment Readiness in an Urban County Jail System

Incarcerated people are disproportionately impacted by the hepatitis C virus (HCV). The purpose of this needs assessment was to characterize the population of incarcerated people with anti-HCV antibodies in one county jail system and assess the readiness of medical staff and patients for scaling up jail-based treatment. Logistic regression was used to identify factors associated with new HCV diagnoses in a retrospective cohort of patients completing HCV antibody and viral load testing between 2016 and 2021. Semistructured interviews were also conducted with 31 incarcerated people and 6 jail health services staff and thematically analyzed to identify barriers to and facilitators of jail-based HCV treatment. Of 6,282 people completing HCV antibody testing between 2016 and 2021, 79 (1.3%) were incarcerated long enough with a confirmed, active HCV infection to be cured, but were not. Of the incarcerated interviewees, 36% (8 people) preferred jail-based treatment of HCV. Jail health services staff were universally ready and willing to provide treatment in jail, should the budget allow. Many incarcerated people can be successfully diagnosed and cured of HCV in jail, and both incarcerated people and those who provide their health care desire jail-based treatment.