Implementing a Low-Threshold Hepatitis C Treatment in a Jail Setting

PROJECT SUMMARY Carceral facilities, particularly jails, present a unique opportunity to address the public health crisis of hepatitis C virus (HCV) and HIV among people who inject drugs (PWID). With two-thirds of PWID experiencing incarceration in the United States and a high HCV/HIV seroprevalence in these settings, jails become a critical access point for addressing the hepatitis C epidemic. Recent studies demonstrate the potential for low-barrier HCV treatment models (e.g., the “minimal monitoring” MINMON protocol) to cure hepatitis C, even among high-risk patient populations including those with active drug use. Despite this, HCV treatment in jails, which are characterized by high turnover and short-term stays, is rare. This represents a missed public health opportunity, contrasting with the success of HCV treatment seen in long-term prison facilities. This planning grant seeks to fill this critical gap by piloting an innovative, low-barrier HCV treatment strategy in a jail setting. Coined “MINMON-J,” this approach modifies the MINMON protocol for use in jails. MINMON-J incorporates take-home HCV medication and collaboration with a community Transitions Clinic, leveraging community health workers (CHWs) to support patient navigation and post-release linkage to care. In Aim 1, the study aims to evaluate the feasibility and effectiveness of MINMON-J through a single-arm pilot trial involving jailed PWID with HCV mono-infection or co-infection with HIV. Participants will receive rapid HCV treatment initiation while incarcerated. Individuals released before treatment will receive all remaining medication and CHW-facilitated peer navigation. Outcomes, assessed using the RE-AIM/PRISM framework, will include HCV cure rates and various implementation outcomes to inform a subsequent stepped-wedge Type 1 hybrid effectiveness-implementation trial. In Aim 2, in-depth interviews will help characterize facilitators and barriers to low-barrier HCV treatment in a jail to refine the approach for broader implementation in similar settings. This research serves to establish a transformative, community-informed strategy for HCV treatment in jail settings, addressing a significant public health need. The outcomes of this pilot study have the potential to shift paradigms in HCV elimination strategies, particularly for PWID and people living with HIV, aligning with the goals of national health agencies, and contributing to the broader effort of HCV elimination.