Changes in hepatitis C virus infections after implementation of an expanded treatment program in New Mexico state prisons

Background

Numerous leading health organizations have developed plans to eliminate hepatitis C virus (HCV), but the success of these efforts can only be assessed through systematic monitoring of infections. People in prison are at very high risk for HCV infection and New Mexico (NM) prisons have one of the highest rates of HCV in the US For nearly two decades NM Corrections Department (NMCD) and Project ECHO® have been partnering to treat HCV in NM state prisons, including a significant expansion in treatment in 2020. Since the start of the treatment scale-up in 2020, 2981 people have been treated. Treatment expansion also allowed for the expanded data collection on HCV testing as people enter the prison system. The purpose of this analysis was to assess changes in HCV infections in state prisons after treatment expansion.

Methods

From February 2021 to November 2024, ECHO received weekly reports on entrants coming into the prisons who tested positive for HCV antibody (Ab) and/or HCV RNA. Demographic and clinical details were only available for the entrants who are HCV RNA positive (viremic), so we were unable to adjust for demographics. Poisson regression was used to assess changes in the RNA positivity (HCV viremia) and Ab positivity among the total entrant population.

Results

Of the 7689 entrants, 3917 (50.9 %) were Ab positive and 2456 (31.9 %) were viremic. HCV viremia among all entrants decreased significantly over time (Poisson rate ratio (RR): 0.9989, CI: 0.9981 - 0.9996, p = < 0.01). Ab positivity among all entrants did not change (Poisson RR: 1.0, CI: 0.9999 - 1.00, p = 0.08).

Conclusion

HCV viremia has decreased among entrants of NM state prisons, but Ab positivity has not changed. Other factors could be influencing the decrease in HCV viremia, including community treatment and shifting patterns in injection drug use, but it is likely that the expansion of treatment in carceral settings among high-risk populations is contributing to the decline in HCV viremia in prisons statewide. The collaboration between NMCD and Project ECHO may be contributing to decreasing HCV in state prisons.