Hepatitis C: Bronx Program Keeps Former Prison Inmates in Treatment

Prisoners who are able to get hepatitis C antivirals while they are still incarcerated can be lost to treatment when they are freed. A community linkage program in the Bronx, NY is having success keeping the patients on their drug regimens.

One problem with making sure that people who get treatment for hepatitis C while in prison complete their antiviral regimens is lack of follow-up when they are released.

In a presentation at IDWeek 2016 in New Orleans, LA, Matthew Akiyama, MD, of New York City’s Montefiore Medical Center/Albert Einstein College of Medicine and colleagues described a new program coordinating community and jail-based hepatitis C intervention. The initiative is showing early signs that it keeps patients connected to care outside of the institution.

Through statistical analysis of New York City Department of Health records from 2014 through early 2015 for Hepatitis C in the Correctional-Community Continuum of Care: Poor Baseline Linkage Rates and Early Improvement with Care Coordination researchers determined the rate of patient “linkage” to HCV treatment in the critical days after release from incarceration.

For purposes of the study linkage was defined by documentation of a hepatitis C infection, HCV viral load, or genotype <90 days in the community after release from an index incarceration.

The initial results on this ongoing study show a marked increase in patients linked to care. While a mere 12% of patients in the pre-intervention group presented as linked to care in the community post intervention linkage was around 60%.

The Coordination of Care Program (CCP) includes needs assessment, HCV education, and a robust appointment scheduling component complete with reminder calls and a community patient navigator to escort recently incarcerated patients to their community clinic.

Statistical significance was determined using x2 tests.

Of 52 patients in the pre-intervention group, 24 (46.2%) were released from their index jail stay.

Of those released, 10/24 (42%) returned to the system within a median of 247 days (IQR 129-318).

The remaining 28 individuals were not released from their index incarceration and were transferred to a state prison.

Of the 26 enrolled in the CCP as of April 2016, 13 (50%) have been released of whom six are linked, four are pending linkage, and three are not linked.

Nine people (34.6%) have not yet been released, and four (15.4%) have been transferred to a state prison.

Criteria for linkage to care within <90 days in the pre-intervention and intervention groups respectively were met by three out of 24 (12.5%) vs. five out of nine thus far (55.6%) (p=0.01)

Overall linkage to care within <90 days in the pre-intervention and intervention groups respectively by 11 out of 24 (45.8%) vs. six out of nine so far (66.7%) (p=0.29).

In conclusion the team determined re-intervention linkage rates were low, and found linkage in <90 days was significantly higher in the intervention group though not overall.

“These data provide early evidence that an integrated community-based CCP with jail-based transitional care coordinators may be effective in improving timely linkage to HCV care following release from jail,” they said.

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Hepatitis C | MD Magazine