Policing/Incarceration
Impact of jail-based methadone or buprenorphine treatment for opioid use disorder on Hepatitis C Virus outcomes immediately after release from New York City jails, 2011-2018 Sungwoo Lim* Sungwoo Lim Teena Cherian Sarah Braunstein Ellen Wiewel Zachary Rosner Monica Katyal Noa Krawczyk Maria Khan Sean Murphy Ali Jalali Philip Jeng Keith Goldfeld Ross MacDonald Joshua Lee
Hepatitis C virus (HCV) care services have been available in New York City (NYC) jails since the 2010s, with efforts to scale up screening and treatment. HCV treatment, while simplified over the last decade, takes weeks and can be complicated to coordinate for people transitioning from community to jail and, often, back in short time. In-jail methadone or buprenorphine treatment for opioid use disorder (MOUD) is associated with increased measures of stability following re-entry. This impact might translate into HCV outcomes in people with OUD but its evidence is limited. We tested whether in-jail MOUD is associated with first HCV ribonucleic acid (RNA) negative test result post-release at NYC healthcare facilities among individuals with OUD and HCV diagnoses prior to release. NYC jail-based patient electronic medical records were matched with NYC mortality and HCV registries. The cohort included 2817 adults who were incarcerated and released to the community in 2011-18. They experienced 4507 treatment (MOUD) and 2190 comparison (no MOUD) incarceration events. Outcome was time to the first test date post-release with undetectable RNA since the first HCV diagnosis. We conducted multivariable mixed-effect Cox regression analysis with demographic, health, and legal characteristics as potential confounders, and a frailty factor to address subsequent incarcerations by unique individual. The one-year post-release period was broken into the first month and remaining time to address the proportionality assumption violation. Treatment and comparison groups were similar except for percentages of males (79% vs. 90%), felony charge (27% vs. 59%), length of jail stay (median 20 days vs. 51 days), and injection drug use (75% vs. 70%). Adjusted HR for the outcome by in-jail MOUD was 4.96 (95% CI=1.74-14.12) within 28 days, and 1.14 (95% CI=0.81-1.59) for the remaining time. In-jail MOUD is associated with increased HCV clearance rates in the immediate post-release period.