This project evaluates a Hepatitis C (HCV) treatment model in a county jail setting in Asheville NC. A regional nonprofit community clinic, local county detention center, care coordination community-based organization and regional harm reduction organization (HRO) collaborated. Between April 2024 and March 2025 six semi-structured interviews with representative stakeholders were conducted to identify stakeholder-perceived barriers and potential solutions. Interviews were transcribed and coded by two coders. Results showed barriers related to jail setting, staffing, and funding frequently mentioned by interviewees. Interagency partnerships, shared workflows and case management were crucial components for successful treatment model implementation. Jails remain underutilized for HCV intervention. With appropriate resources, treatment in this setting is feasible. Innovative, community driven models can significantly contribute to HCV elimination and improve public health within the carceral system and in communities. The results of this project indicate that the future policymaking should target jail settings in efforts to decrease disease transmission and the burden of the HCV in Western North Carolina and beyond.
AbeC. M., AguwaM., ZhaoM., SullivanJ., PorsaE., NijhawanA. E. (2019). Hepatitis C virus infection in the Dallas County Jail: Implications for screening, prevention, and linkage to care. Public Health Reports®, 134(6), 626–633. 10.1177/0033354919874081
2.
Abu-FrehaN., Mathew JacobB., ElhoashlaA., AfawiZ., Abu-HammadT., ElsanaF., PazS., EtzionO. (2022). Chronic hepatitis C: Diagnosis and treatment made easy. European Journal of General Practice, 28(1), 102–108. 10.1080/13814788.2022.2056161
3.
AgroiaH., WalshK., & GillR. K. (2024). Patient Perceptions of Hepatitis C Screening and Diagnosis While in a County Jail. Journal of Correctional Health Care, 30(5), 339–346. 10.1089/jchc.24.04.0039
4.
AkiyamaM. J., RossJ., RimawiF., FoxA., JordanA. O., WiersemaJ., LitwinA. H., KabaF., & MacDonaldR. (2020). Knowledge, attitudes, and acceptability of direct-acting antiviral hepatitis C treatment among people incarcerated in jail: A qualitative study. Plos One, 15(12), e0242623. 10.1371/journal.pone.0242623
5.
AntenangeliL., & DuroseM. (2021). Recidivism of prisoners released in 24 States in 2008: A 10-year follow-up period (2008–2018).
6.
BhattacharyaD., AronsohnA., PriceJ., & Lo ReV. (2023). Hepatitis C guidance 2023 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases, 77(7), e25–e83. 10.1093/cid/ciad319
7.
CDC. (2022). At-a-glance: CDC recommendations for correctional and detention settings testing, vaccination, and treatment for HIV, viral hepatitis, TB, and STIs. https://stacks.cdc.gov/view/cdc/120256.
ChakE., TalalA. H., ShermanK. E., SchiffE. R., & SaabS. (2011). Hepatitis C virus infection in USA: An estimate of true prevalence. Liver International, 31(8), 1090–1101. 10.1111/j.1478-3231.2011.02494.x
10.
ChanJ., AkiyamaM. J., JulianE., JosephR., McGaheeW., RosnerZ., YangP., & MacDonaldR. (2024). Treating Hepatitis C virus infection in jails as an offset to declines in treatment activity in the community, New York City, NY, 2014–2020. AJPM Focus, 3(2), 100185. 10.1016/j.focus.2024.100185
11.
DamschroderL. J., AronD. C., KeithR. E., KirshS. R., AlexanderJ. A., & LoweryJ. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science: IS, 4(1), 50. 10.1186/1748-5908-4-50
12.
FoxR. K., CurrieS. L., EvansJ., WrightT. L., ToblerL., PhelpsB., BuschM. P., & Page‐ShaferK. A. (2005). Hepatitis C virus infection among prisoners in the California state correctional system. Clinical Infectious Diseases, 41(2), 177–186. 10.1086/430913
13.
HoffE., WardenA., TaylorR., & NijhawanA. E. (2023). Hepatitis C epidemiology in a large urban jail: A changing demographic. Public Health Reports®, 138(2), 248–258. 10.1177/00333549221076546
14.
HsiehH. F., & ShannonS. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. 10.1177/1049732305276687
15.
HuntD. R., SaabS. (2009). Viral hepatitis in incarcerated adults: A medical and public health concern. The American Journal of Gastroenterology, 104(4), 1024–1031. 10.1038/ajg.2008.143
16.
LaffertyL., RanceJ., ByrneM., MilatA., DoreG. J., GrebelyJ., LloydA. R., & TreloarC. (2022). “You need a designated officer”—Recommendations from correctional and justice health personnel for scaling up hepatitis C treatment-as-prevention in the prison setting. International Journal of Drug Policy, 106, 103746. 10.1016/j.drugpo.2022.103746
17.
LarneyS., KopinskiH., BeckwithC. G., ZallerN. D., JarlaisD. D., HaganH., RichJ. D., Van Den BerghB. J., & DegenhardtL. (2013). Incidence and prevalence of hepatitis C in prisons and other closed settings: Results of a systematic review and meta-analysis. Hepatology, 58(4), 1215–1224. 10.1002/hep.26387
18.
MacDonaldR., AkiyamaM. J., KopolowA., RosnerZ., McGaheeW., JosephR., JafferM., & VentersH. (2017). Feasibility of treating Hepatitis C in a transient jail population. Open Forum Infectious Diseases, 4(3), ofx142. 10.1093/ofid/ofx142
19.
Montoya-BarthelemyA. G., LeeC. D., CundiffD. R., & SmithE. B. (2020). COVID-19 and the correctional environment: The American prison as a focal point for public health. American Journal of Preventive Medicine, 58(6), 888–891. 10.1016/j.amepre.2020.04.001
OwensD. K., DavidsonK. W., KristA. H., BarryM. J., CabanaM., CaugheyA. B., CurryS. J., DoubeniC. A., EplingJ. W.Jr, KubikM., LandefeldC. S., MangioneC. M., SilversteinM., SimonM. A., TsengC.-W., & WongJ. B. (2020). Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA, 323(10), 970–975. 10.1001/jama.2020.1123
22.
RyanH., DoreG. J., GrebelyJ., ByrneM., CunninghamE. B., MartinelloM., LloydA. R., & HajarizadehB. (2024). Hepatitis C treatment outcome among people in prison: The SToP ‐C study. Liver International, 44(11), 2996–3007. 10.1111/liv.16074
23.
SchillieS., WesterC., OsborneM., WesolowskiL., & RyersonA. B. (2020). CDC recommendations for hepatitis C screening among adults—United States, 2020. MMWR Recommendations and Reports, 69(2), 1–17. 10.15585/mmwr.rr6902a1
24.
Smith-PalmerJ., CerriK., & ValentineW. (2015). Achieving sustained virologic response in hepatitis C: a systematic review of the clinical, economic and quality of life benefits. BMC Infectious Disease, 15(1).
World Health Organization. (2016). Global Health Sector Strategy on Viral Hepatitis 2016-2021. Towards Ending Viral Hepatitis.
28.
WurcelA. G., ReyesJ., ZubiagoJ., KoutoujianP. J., BurkeD., KnoxT. A., ConcannonT., LemonS. C., WongJ. B., FreundK. M., BeckwithC. G., & LeClairA. M. (2021). “I’m not gonna be able to do anything about it, then what’s the point?”: A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail. Plos One, 16(5), e0250901. 10.1371/journal.pone.0250901
