The Value of Eliminating Hepatitis C in Jails
Summary
- A new study led by the Miller School of Medicine’s Dr. Lin Zhu evaluates the impact of accelerating elimination of hepatitis C with jail-based interventions.
- Dr. Zhu’s work revealed the test-and-treat plus navigation strategy reduced cumulative person‑years of infection , incidence and hepatitis C‑related deaths among PWID both within and outside jail settings,
- Dr. Zhu’s research shows jail‑based interventions reduce new infections and deaths among people who inject drugs while remaining highly cost‑effective.
Hepatitis C remains a stubborn public health challenge in the United States, especially among people who inject drugs (PWID). A new modeling study led by Lin Zhu, Ph.D., an assistant professor in the Department of Public Health Sciences at the University of Miami Miller School of Medicine, evaluates the impact of accelerating elimination.
The findings, published in JAMA Internal Medicine, are striking. Comprehensive, jail‑based interventions reduce new infections and deaths among PWID while remaining highly cost‑effective.
“Jail-based interventions lead to benefits among PWID both within and outside of jails,” said Dr. Zhu, “and providing treatment in jail is cost-saving compared to testing alone.”
Environments for Effective Hepatitis C Interventions
PWID face barriers to care like unstable housing, limited insurance and stigma that impede screening and treatment. They also have high rates of hepatitis C and high rates of incarceration, which create unique opportunities to reach people who might otherwise miss hepatitis C services. The study team modeled an urban environment similar to Philadelphia, incorporating data from programs like Philadelphia FIGHT that routinely test, treat and provide post‑release navigation.
Dr. Zhu and team extended an agent‑based, dynamic network model of hepatitis C transmission through shared injection equipment to include transitions between community and jail. The simulation tracked outcomes over 50 years following a 10‑year intervention period, capturing person‑years of infection, incidence, hepatitis C–related mortality, quality‑adjusted life years (QALYs) and costs.
Five strategies were compared:
• Status quo (no jail intervention)
• Test at jail entry
• Test and navigation after release from jail
• Test and treat with direct‑acting antiviral therapy in jail
• Test and treat plus navigation
Key Results: Increased Health, Economic Value
Dr. Zhu’s work revealed the test-and-treat plus navigation strategy reduced cumulative person‑years of infection by 35%, incidence by 47% and hepatitis C‑related deaths by 40% among PWID both within and outside jail settings, compared with no jail intervention. Economically, the combined strategy had an incremental cost-effectiveness ratio (ICER) of about $11,000 per QALY gained, well below commonly cited U.S. cost‑effectiveness thresholds ($50,000 to $150,000 per QALY).
Notably, adding treatment in jail was cost‑saving or yielded more favorable ICERs versus testing alone and strategies with navigation achieved more favorable ICERs than comparable strategies without navigation.
The study did not include fixed startup costs or comprehensive jail‑budget impact analyses, reflecting limited published data. It also did not explicitly model jail‑to‑prison transitions, which could influence transmission dynamics and continuity of care.
Nonetheless, even conservative scenarios maintained strong cost‑effectiveness. For communities striving to meet national elimination targets, integrating jails into hepatitis C care networks is a practical, evidence‑based step that can save lives while making smart use of health care resources.
Tags: Department of Public Health Sciences, Dr. Lin Zhu, hepatitis C, Infectious diseases, public health sciences