implementing low-barrier hcv treatment in a jail setting

Conditions: HEPATITIS C (HCV); Incarceration; Injection Drug Use; Implementation Science

Summary: the goal of this clinical trial is to learn whether a low-barrier treatment program can help people with hepatitis c virus (hcv) who are in jail start and complete treatment more easily. this study focuses on adults at the rhode island department of corrections who have active hcv and are awaiting trial. the study asks: * can a simplified, low-barrier hcv treatment program work in a jail setting? * do participants finish treatment and get cured using this approach? all participants will receive a 12-week course of the hcv medication sofosbuvir/velpatasvir (epclusa). if they are released before completing treatment, they will take the remaining doses with them. community health workers (chws) will help support participants after release, including reminding them to take medications and helping them get follow-up lab work. researchers will measure: * whether participants are cured of hcv * whether the treatment approach is easy to use (feasible), acceptable, and followed correctly (fidelity) * whether the program could be used in other jails or expanded in the future this study may help bring hcv treatment to more people in jail, reduce community spread of the virus, and support national goals to eliminate hcv.

this is a hybrid effectiveness-implementation pilot study testing a simplified model of hepatitis c virus (hcv) treatment called minmon-j, based on the successful "minimal monitoring" approach used in community settings. the study takes place at the rhode island department of corrections (ridoc), a statewide unified jail and prison system. the goal is to assess whether low-barrier hcv treatment can be feasible, acceptable, and effective when started in jail, especially for individuals who inject drugs. participants will receive a full 12-week course of sofosbuvir/velpatasvir (epclusa) with no lab monitoring required during treatment. those released before completing treatment will be given take-home medication and supported by community health workers (chws) post-release. chws will check in with participants, support medication adherence, and help coordinate follow-up testing. the study will enroll 40 adults with active hcv who are awaiting trial and meet other medical and safety criteria. implementation outcomes will be assessed using the prism/re-aim framework. these include: feasibility: can the treatment be delivered as planned in the jail setting? acceptability: do participants and providers find the program acceptable? fidelity: do participants take the medication as prescribed? effectiveness: are participants cured of hcv (measured by svr12)? maintenance: do participants remain engaged in care or avoid reinfection 6 months later? additional data will include participant demographics, adherence rates, and program costs (via the coins framework). participants and staff will also take part in qualitative interviews to understand their experience and identify ways to improve implementation. results will inform a future larger trial and contribute to efforts to scale up hcv treatment in carceral settings as part of national hcv elimination efforts.

Eligibility criteria:
inclusion criteria: * incarcerated individual at ridoc * age ≥ 18 years * awaiting trial (i.e., not sentenced) * english speaking * diagnosis of active hcv (hcv rna \>1000 iu/ml within 90 days prior to study entry) * treatment-naïve for current hcv infection * no cirrhosis (fib-4 score \<3.25 within 90 days prior to study entry) * self-report of injection drug use * ability and willingness to be contacted after jail release * verbal commitment to continue medication after discharge * desire to receive sofosbuvir/velpatasvir (epclusa) exclusion criteria: * cirrhosis (fib-4 score \>3.25 within 90 days prior to study entry and/or clinical signs of cirrhosis) * positive for hepatitis b surface antigen * actively pregnant or breastfeeding * known allergy/sensitivity to study drug components * acute or serious illness requiring hospitalization at enrollment * documented severe persistent mental illness (spmi) by ridoc * any clinical history of hepatic decompensation (e.g., ascites, sbp, he, hrs, variceal bleeding) * hiv-positive with active or acute aids-defining opportunistic infection within 90 days

Keywords: hepatitis c incarceration jail injection drug use minimal monitoring minmon implementation science