Hepatitis C Challenges & Opportunities

among Justice Involved Persons Kristen Dauss, MD

Indiana Department of Correction

Chief Medical Officer

Objectives

• Current treatment approaches within correctional settings

• Define the impact, growing public health and fiscal crisis of HCV in persons with justice involvement

• Understand the unique opportunities regarding HCV treatment for justice involved persons

Jails vs. Prisons

• Jails = county • 92 counties, 92 sheriffs, 91 jails

• Prisons = state • 17 adult facilities, 4 juvenile facilities

What we know…

• Prevalence of HCV infection in correctional institutions >> community

• Inconsistency of assessment/treatment of HCV between jails and prisons

• There are evidence based standards as well as correctional considerations

Current IDOC Approach

• Consent

• Screen all

• Follow all closely

• Enroll all in substance use treatment

• Triage

• Treat

We are ahead of the game!

Local Partnerships

• Sister State Agencies • ISDH

• Response teams (Division of HIV/STD/Viral Hepatitis, CMO, Project ECHO, lab)

• FSSA • OMPP (Medicaid data sharing, HCV Tx Medicaid)

• Community Partners/Researchers • VA

• Grassroots Community/County initiatives

National Partnerships

Challenges

Opportunities

Structure: Louisiana will pay a drug manufacturer for unlimited access to

treatment for individuals in Louisiana for a set annual cost over a set contractual period

Populations included: Medicaid, Corrections

Amount: Annual payment to the manufacturer would be equal to or less than what the state

is currently spending annually to provide antiviral medications to these populations

$30M in Medicaid, $5M in Corrections (pre-

rebate)

Outcome: “Win-win-win” Manufacturers: predictable

revenue, gain in market share, good news

State: predictable expenditures, opportunity to eliminate HCV

Patients: increased SVR, reduced morbidity, reduced

mortality

HUGE Opportunity = HCV Elimination • Continue screening • Implement EBP • Expand provider capacity to treat HCV • Educate persons incarcerated (via

healthcare staff, peer educators, technology, incorporate other IDs)

• Press for support • Implement harm reduction and

complementary treatment strategies • Establish community and correctional

linkages (Medicaid, enhanced continuity of care)

• Extend elimination efforts to all jails

Thank you!

Questions…

Kristen Dauss, MD

Chief Medical Officer

Indiana Department of Correction

302 W. Washington Street, Room E334

Indianapolis, IN 46204

Office: 317.233.2449

kdauss1@idoc.in.gov

Sources:

• Hepatitis C Drugs: A Look at Emerging “Netflix” Payment Models and Patient-Centered Outcomes Research. NASHP. 05/15/2019.

• Hepatitis C Affinity Group. Opt-Out Screening and Treatment in Corrections. 05/13/2019.

• http://www.aca.org/ACA_PROD_IMIS/Docs/OCHC/HCVinCorrectionalSetting_Final.pdf Accessed 06/21/2019.