Linkage to hepatitis C care after incarceration in jail: A prospective, single arm clinical trial

Matthew J. Akiyama, Devin Columbus, Ross MacDonald, Alison O. Jordan, Jessie Schwartz, Alain H. Litwin, Benjamin Eckhardt, Ellie Carmody

Research output: Contribution to journalArticle

Abstract

Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. Trial registration: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).

Original languageEnglish (US)
Article number703
JournalBMC Infectious Diseases
Volume19
Issue number1
DOIs
StatePublished - Aug 8 2019

Fingerprint

Hepatitis C
Hepacivirus
Clinical Trials
Patient Navigation
Community Health Services
Alcoholic Intoxication
Methadone
Therapeutics
Hispanic Americans
Social Support
Drinking
Substance-Related Disorders
Length of Stay
Emotions
Public Health
Health
Sustained Virologic Response

Keywords

  • HCV
  • Jail
  • Linkage to care
  • Prison
  • PWID

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Akiyama, M. J., Columbus, D., MacDonald, R., Jordan, A. O., Schwartz, J., Litwin, A. H., ... Carmody, E. (2019). Linkage to hepatitis C care after incarceration in jail: A prospective, single arm clinical trial. BMC Infectious Diseases, 19(1), [703]. https://doi.org/10.1186/s12879-019-4344-1

Linkage to hepatitis C care after incarceration in jail : A prospective, single arm clinical trial. / Akiyama, Matthew J.; Columbus, Devin; MacDonald, Ross; Jordan, Alison O.; Schwartz, Jessie; Litwin, Alain H.; Eckhardt, Benjamin; Carmody, Ellie.

In: BMC Infectious Diseases, Vol. 19, No. 1, 703, 08.08.2019.

Research output: Contribution to journalArticle

Akiyama, MJ, Columbus, D, MacDonald, R, Jordan, AO, Schwartz, J, Litwin, AH, Eckhardt, B & Carmody, E 2019, 'Linkage to hepatitis C care after incarceration in jail: A prospective, single arm clinical trial', BMC Infectious Diseases, vol. 19, no. 1, 703. https://doi.org/10.1186/s12879-019-4344-1
Akiyama, Matthew J. ; Columbus, Devin ; MacDonald, Ross ; Jordan, Alison O. ; Schwartz, Jessie ; Litwin, Alain H. ; Eckhardt, Benjamin ; Carmody, Ellie. / Linkage to hepatitis C care after incarceration in jail : A prospective, single arm clinical trial. In: BMC Infectious Diseases. 2019 ; Vol. 19, No. 1.
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abstract = "Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31{\%}) linked to HCV care within a median of 20.5 days; 17 (20{\%}) initiated HCV treatment, 15 (18{\%}) completed treatment, 9 (11{\%}) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8{\%}) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78{\%}. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. Trial registration: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).",
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AB - Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. Trial registration: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).

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