Key takeaways: Hepatitis C Interventions in Prisons and Jails Symposium

12 December 2025

The 2025 Hepatitis C Interventions in Prisons and Jails Symposium was delivered in Baltimore as an official pre-conference event to the National Conference on Correctional Health Care (NCCHC). Tailored specifically for professionals working across jails and prisons—including clinicians, prison administrators, corrections staff, policymakers, researchers, and community partners—the symposium brought together national experts, frontline practitioners, and system leaders committed to expanding hepatitis C (HCV) services in carceral settings.

This highly interactive full-day program formed part of INHSU’s global Hepatitis C Intervention Symposia Series, which aims to build local capacity, troubleshoot real-world implementation barriers, and strengthen evidence-based models of HCV care.

Event overview

The one-day Symposium was facilitated by INHSU’s Programs and Policy Manager, Olivia Dawson, who opened the day, delivered an overview of the Intervention Toolkit, and introduced other expert faculty, including:

• Dr. Matt Akiyama
• Dr. Alysse Wurcel
• and a panel of U.S. leaders in correctional health, infectious diseases, and HCV elimination.

 

Participants engaged with a structured program including:

• Global, national, and carceral epidemiology of HCV, highlighting the urgent need for scale-up in prisons and jails
• Evidence-based interventions across the HCV care cascade, including point-of-care testing, dried blood spot testing, peer support, patient navigation, and treatment initiation models
• Interactive case discussions on treatment decision-making in custodial environments
• Implementation science training, focusing on the CFIR and RE-AIM frameworks
• A hands-on workshop where small groups designed tailored six-month implementation plans for their facility
• Networking, peer exchange, and community-of-practice building

 

Key themes emerging across the day

1. HCV elimination requires carceral leadership

Data presented underscored that nearly 1 in 3 people living with HCV in the United States spend part of the year incarcerated, making jails and prisons essential to national elimination goals. Participants echoed that health and carceral leadership must increasingly view HCV programming as central to public health and re-entry planning, not ancillary.

2. Testing must be simplified, scaled, and embedded

Common themes included:

• The need for opt-out screening at intake, though challenges remain around  understanding, and operationalisation
• Value of reflex testing, point-of-care RNA testing platforms, and dried blood spot (DBS) approaches to overcome phlebotomy barriers
• Consistent message: testing opportunities should occur at intake, during housing transitions, and pre-release

 

Frontline staff emphasised that testing workflows must be feasible within security constraints, staff capacity, and rapid turnover in jails.

3. Treatment is possible—and necessary—in carceral settings

Groups discussed myths about deferring treatment, and the imperative to treat in both jails and prisons to achieve national elimination goals.

4. Implementation barriers are shared nationally

Session 3 group work revealed remarkably consistent challenges across facilities:

• Funding and workforce shortages
• Electronic Medical Record (EMR) incompatibility and poor data transfer
• Security–health communication gaps
• Limited space for clinical activities
• Stigma, provider confidence, and training needs
• Unclear or inconsistent post-release pathways

 

Outer-setting factors such as Medicaid policies, pharmacy access, transportation, and broader social determinants of health (SDoH) were also frequently cited.

5. Strong partnerships drive success

Participants emphasised the importance of:

• Collaborating with community health providers
• Engaging peer educators and navigators
• Creating MoUs for data sharing, release planning, and communication
• Bringing community clinicians into correctional facilities to close linkage gaps

 

Peer support and patient navigation were highlighted as particularly high-impact interventions that humanise the care journey and improve follow-up after release.

6. Implementation science helps bridge the knowing–doing gap

Using CFIR, groups mapped barriers and facilitators across inner and outer systems. Through RE-AIM, they translated ideas into practical strategies, including metrics for reach, adoption, and sustainability. Teams left with concrete six-month action plans tailored to local context—ranging from establishing discharge-planning teams to training staff, launching intake testing, and developing cross-agency MoUs.

Impact of the symposium

The Baltimore symposium strengthened the growing national movement toward carceral HCV elimination by:

• Building knowledge and confidence: Participants gained evidence-based guidance on testing, treatment, and care models—many noting that the sessions clarified misconceptions and simplified approaches to starting HCV programs.
• Creating a shared problem-solving space: The event fostered a rare opportunity for correctional and community health providers to collaborate openly, comparing challenges and solutions across diverse institutions and states.
• Accelerating implementation: Through applied implementation science, facilities left with tangible, actionable plans ready to put into practice within six months. Many participants identified immediate next steps that did not require additional funding.
• Strengthening national networks:The symposium contributed to INHSU’s ongoing Community of Practice, linking attendees to follow-up webinars, case discussions, and national resources that extend the learning beyond a single day.
• Supporting the National HCV Elimination Plan: By equipping frontline staff with tools to scale up testing and treatment, the symposium directly advances U.S. efforts to expand diagnostic access in this important setting.

 

Conclusion

The Symposium in Baltimore demonstrated both the complexity and the possibility of scaling up HCV care in U.S. prisons and jails. Participants left with renewed momentum, strengthened partnerships, and a clear roadmap for action—grounded in practicality, collaboration, and a shared commitment to eliminating hepatitis C as a public health threat.

If you require additional resources or connection to the community of practice, please contact Olivia Dawson (INHSU) at [email protected].