Universal Opt-Out Hepatitis C Virus Testing and Treatment on Entry in California State Prisons

Background: Correctional facilities are vital venues for expanding testing and treatment for hepatitis C virus (HCV) infections, essential components of national hepatitis C elimination plans. Objective: This study characterizes HCV testing and treatment outcomes among individuals entering incarceration into California state prisons, overall, by year, and by key individual-level characteristics. Methods: We analyzed individual-level electronic health record data from all adults entering California prisons ('entrants') between July 1, 2016 and June 30, 2023. We quantified the percentages of entrants receiving an HCV antibody test within four weeks of entry, the percentage antibody positive among tested, the percentage RNA positive among antibody positive, and the percentage initiating direct acting antiviral (DAA) treatment within one year among RNA positive. Results: Of entrants, 133,639 (76%) were tested for HCV antibody, 25,455 (19% of tested) were ever HCV-infected, and 16,738 (66% of ever infected) were currently infected. Among individuals currently infected, 7,479 (45%) initiated DAA treatment within one year. Individuals with identified SUD had 3.2 times higher antibody positivity and 1.3 times higher proportions initiating DAA, compared to individuals not having an identified SUD. Discussion: We show that HCV testing and treatment in California prisons, a central component of national hepatitis C elimination efforts, supported effective and equitable increases in access to hepatitis C treatment, particularly for those with SUD.