Leveraging the AIDS Drug Assistance Program to Cure Hepatitis C in People With HIV in Jail

Abstract

Hepatitis C virus (HCV) infection is highly prevalent in U.S. jails, yet access to curative direct-acting HCV therapy remains limited because of the inmate Medicaid exclusion rule. However, an innovative expansion of the AIDS Drug Assistance Program in California now supports HCV treatment for individuals experiencing incarceration who are living with HIV. We describe the implementation of this pilot program in the Los Angeles County Jail, including the formation of a multidisciplinary task force designed to rapidly identify, evaluate, and initiate treatment despite the unpredictable length of stay and other barriers. Enabling treatment delivery within jail constraints has been possible with program adaptations such as provision of remaining HCV medications at release, shortened regimens and use of early sustained virologic response. Although challenges remain—including lack of universal screening, no funding for treatment of HCV monoinfection, and limited post-release linkage to care—this pilot demonstrates that targeted policy innovation combined with an effective implementation team can expand access to lifesaving HCV care in carceral settings in a group at very high risk.