by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

April 9, 2024

Featured Literature:

Lucas KM, Krawiec A, Wada J, Kanan RJ.  The hepatitis C care cascade in California state prisons: screening and treatment scale-up and progress toward elimination, 2016 – 2023.  Clin Liver Dis.  2024 Apr 2;23(1):e0117  doi: 10.1097/CLD.0000000000000117.  PMID: 38567093. 

This analysis describes scale-up and 1-year care cascade outcomes of the California Correctional Health Care Services (CCHCS) hepatitis C program after integration of universal opt-out screening.  From 2016 to 2023, CCHCS offered opt-out screening with reflex RNA at entry.  In 2016-2017, the program’s care delivery model transitioned from requiring individual PCP approval requests to a centralized team model, and then finally a hub and spoke approach was utilized 2018-2023.  In earlier years (2016-2018) designated HCV specialists treated all patients, then from 2018-2023 PCPs treated most cases and HCV specialists treated complex ones.  In 2019-2020, nursing was introduced to coordinate pre-treatment work-up and monitoring and provide risk reduction counseling.  During the review period, CCHCS also shifted from treating only cases of advanced fibrosis/liver disease to universal treatment.  During FY 2018-2019, 32,365/35,594 (93.6%) people were screened and 4127/5705 (72.3%) with reactive HCV Ab had viremia; subsequently, 8612/11,638 (74.0%) previously unscreened residents underwent screening and 540/735 (73.5%) with reactive HCV Ab had viremia.  Of 15,320 people eligible for treatment (on July 1, 2018), 6147 (40.1%) initiated treatment within the year and 5501 had known treatment completion outcomes: 3736/3937 (94.9%) achieved SVR12.  HCV reinfection per 100 PYFU ranged from 6.7 among all who achieved SVR to 24.2 among retested individuals.

Author’s Commentary:

California has one of the largest correctional systems in the United States.  This paper describes high rates of screening, treatment, and SVR during the first year of HCV program scale-up which incorporated critical elements such as broader screening, universal treatment, and a ‘decentralized’, multi-professional care team.  Since the start of CCHCS treatment scale-up, population prevalence of viremia has decreased and authors note these outcomes demonstrate program “sustainability and progress toward WHO [goals]” and that “impact of these programs could be improved with access to harm reduction strategies aimed at primary prevention for people who use or inject drugs.”    

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