Improvement in time to hepatitis C virus treatment in New Mexico state prisons, 2020-2024

Background New Mexico (NM) state prisons have one of the highest rates of hepatitis C virus (HCV) in the United States. Delayed treatment for HCV can result in reduced quality of life, cirrhosis, liver cancer, and decreased life expectancy. Early detection and treatment halts disease progression and saves lives. Project ECHO (Extension for Community Healthcare Outcomes) began collaborating with the NM Corrections Department (NMCD) in 2004 to establish an HCV treatment program supported with the ECHO model. In 2020, ECHO, NMCD, and NMCD’s medical vendor revised their HCV treatment guidelines to significantly increase the number of people receiving HCV treatment using direct-acting antivirals. NMCD, ECHO, and NMCD’s medical vendor met regularly to address issues and revise clinical guidelines and decrease time to treatment. The objective of this analysis was to assess changes in time to treatment after treatment expansion. Methods Time to treatment was measured in days from prison intake to the first HCV treatment, using only the earliest intake and treatment dates, with the year categorized by the treatment start date. Kaplan-Meier curves, Log-rank test, and Cox proportional hazards regression were used to assess changes in time to treatment by year after adjustment for age, gender, and cirrhosis status. Results For the five years with complete data since treatment expansion (2020, 2021, 2022, 2023, and 2024), 2,631 unique people were HCV RNA positive upon entry and received HCV treatment in NM state prisons. Most people who received treatment were aged 30–44 (61.8%), and male (92.6%). Overall, time to treatment was 12.7 times faster in 2024 compared to 2020 (p < 0.001) when adjusted by age group, gender, and cirrhosis status. Conclusion Time to treatment was considerably reduced in the four years following treatment expansion in NM state prisons. Expanding HCV treatment and improving time to treatment is critical in reducing the risk of HCV transmission and improving quality of life for HCV-infected people.