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.

Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other authors’ affiliated institutions.

The authors have declared no competing interest.

This project was funded by the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (NEEMA; award #NU38PS004651). The funder had no role in the study design, analysis, writing, or decision to submit the manuscript for publication. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other authors' affiliated institutions.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was determined by the Stanford University Institutional Review Board to be non-human subjects research (Protocol #72584).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Individual-level data from California Correctional Health Care Services are not publicly accessible and require a data use agreement. Analytic code and aggregate results are accessible at: https://github.com/PPML/cchcs_hcv_screening_manuscript.

https://github.com/PPML/cchcs_hcv_screening_manuscript