A Case-Control Study of Hepatitis C Virus Re-infection in Incarcerated Patients in California Receiving Medication for Opioid Use Disorder

Background Incarcerated people are disproportionately burdened with hepatitis C virus (HCV) infection and experience elevated risk of re-infection following treatment. Medication for opioid use disorder (MOUD) has been shown to reduce, but not eliminate, re-infection. Research is lacking on patient-level factors associated with HCV re-infection in incarcerated populations in the United States receiving MOUD. Methods We conducted a case-control study from secondary data analysis of health records among people incarcerated in California state prisons who initiated HCV treatment, achieved sustained virologic response (SVR), and began MOUD before SVR. Case-patients were re-infected within one year; controls remained HCV-negative at one year. Results Eligible subjects (50 cases; 108 controls) were predominantly male (96.2%), Hispanic/Latinx (62.7%) or White (29.1%), and median age 36 (range 23–60) years. HCV re-infection was independently associated with injection drug use (aOR=3.4; 95% CI: 1.3–8.5), unsterile tattooing (aOR=3.4; 95% CI: 1.2–9.9), methamphetamine use (aOR=2.5; 95% CI: 1.0–6.1), younger age (aOR=0.7; 95% CI: 0.5–0.9; units=5 years), and lower adherence to adequately dosed (≥16mg/day) buprenorphine (aOR=0.7; 95% CI: 0.6–1.0; units=0.25, aOR=0.3; 95% CI: 0.1–0.9; units=1.0). Conclusions Even with complete MOUD adherence, conferring a 70% protective effect for HCV re-infection, patients reported ongoing risk behaviors. Injection drug use, methamphetamine use, and unsterile tattooing also increase the risk other blood-borne or skin and soft tissue infections and overdose. Improved health outcomes could be achieved with integrating enhanced monitoring of MOUD with expanded harm reduction including syringe services and contingency management for treatment stimulant use disorders.