Jail-based hepatitis C programs that include testing, direct-acting antiviral treatment, and post-release support could cut new hepatitis C virus (HCV) infections by 47% among people who inject drugs, according to a simulation study published in JAMA Internal Medicine. The comprehensive approach could also lower hepatitis C-related deaths by 40%, all while costing far less than standard healthcare benchmarks .

Why Are People Who Inject Drugs Falling Behind in Hepatitis C Elimination?

Hepatitis C is transmitted through contact with infected blood, most commonly through sharing needles among people who inject drugs. Without treatment, the infection can cause liver inflammation that may develop into cirrhosis, permanent scarring of the liver, liver failure, or liver cancer. The World Health Organization has committed to eliminating hepatitis C as a significant global public health concern by 2030, and the United States set a goal to reduce hepatitis C infections by 90% and deaths by 65% by 2030. However, the country is not currently on track to meet these targets .

People who inject drugs face unique barriers to healthcare access. Substance use disorder rates run five times higher among justice-involved individuals than in the general population, and one in four people who inject drugs has reported incarceration or detention in the past year. Factors including lack of health insurance, housing instability, and criminalization and stigmatization of drug use create significant obstacles to care .

What Did the Jail-Based Hepatitis C Study Actually Test?

Researchers at the University of Miami Miller School of Medicine and Stanford Medicine used a computer simulation model to predict how hepatitis C spreads among people who inject drugs who cycle in and out of jail. The model was based on real-world data from the Philadelphia FIGHT program, which provides healthcare and support to people facing health disparities. The team tracked simulated outcomes over 60 years following a 10-year implementation of jail-based interventions .

The simulation modeled a group of 1,552 people who inject drugs with a mean age of 32. Without any jail-based interventions, the model projected there would be 662 new infections and 240 hepatitis C-related deaths per 1,000 people who inject drugs over 60 years .

How to Implement Effective Jail-Based Hepatitis C Programs

• Testing at Entry: Screen all individuals for hepatitis C virus when they enter the jail system to identify infections early and prevent further transmission.
• Direct-Acting Antiviral Treatment: Provide direct-acting antivirals (DAAs), a class of medications that achieve a cure in the vast majority of hepatitis C cases, while individuals are incarcerated.
• Post-Release Navigation Support: Offer support services to help people connect with and remain in care after their release from jail, ensuring treatment continuity and preventing reinfection.

The research team compared four jail-based approaches. The first tested for hepatitis C only at jail entry. The second added navigation support to help people connect with and remain in care after release. The third paired hepatitis C testing with direct-acting antiviral treatment while in jail. The fourth combined all three: testing, treatment in jail, and support after release .

The comprehensive fourth approach proved most effective. Compared with no jail-based intervention, this strategy reduced the total time people lived with infection by 35%, cut new infections by nearly half at 47%, and lowered hepatitis C-related deaths by 40% .

"Jail-based interventions lead to benefits among people who inject drugs both within and outside of jails, and providing treatment in jail is cost-saving compared to testing alone," said Lin Zhu, assistant professor at the University of Miami Miller School of Medicine.

Lin Zhu, Assistant Professor at the University of Miami Miller School of Medicine

Is This Approach Affordable for Jail Systems?

From a cost-effectiveness standpoint, the combined strategy performed exceptionally well. Its incremental cost-effectiveness ratio, a standard measure of the cost per unit of health gained, was about $11,000 per quality-adjusted life year (QALY), a measure of disease burden including both the quality and quantity of life lived. This value was far below the commonly used U.S. cost-effectiveness benchmarks of $50,000 to $150,000 per QALY .

In fact, adding treatment in jail was found to be cost-saving relative to testing alone. Including navigation services consistently improved both health outcomes and economic value across all strategies tested .

"Despite restricted jail budgets, these programs for hepatitis C offer substantial health benefits and economic value when integrated into broader public health funding frameworks," explained Joshua Salomon, senior author and professor of health policy at Stanford Medicine.

Joshua Salomon, Professor of Health Policy at Stanford Medicine

The researchers noted some study limitations. The simulations did not account for fixed startup costs or the full budgetary impact on jail systems, partly because of limited published data. The study also did not model transitions from jail to prison, which could affect how the virus spreads and whether people can maintain care .

Currently, few large jails have the capacity and funding to implement hepatitis C programs. However, if adequately resourced, extending these interventions to large and medium-sized jails could accelerate progress toward hepatitis C elimination and help the United States meet its 2030 goals for reducing infections and deaths .