Background: Incarcerated people are disproportionately burdened with hepatitis C virus (HCV) infection and experience elevated risk of reinfection following treatment. Medication for opioid use disorder (MOUD) has been shown to reduce, but not eliminate, reinfection. Research is lacking on patient-level factors associated with HCV reinfection in incarcerated populations in the United States receiving MOUD.
Methods: We conducted a case-control study from secondary data analysis of health records among people incarcerated in California state prisons who initiated HCV treatment, achieved sustained virologic response, and began MOUD before sustained virologic response. Case-patients were reinfected within 1 year; controls remained HCV-negative at 1 year.
Results: Eligible subjects (50 cases; 108 controls) were predominantly male (96.2%), Hispanic/Latinx (62.7%) or White (29.1%), and median age 36 (range, 23-60) years. HCV reinfection was independently associated with injection drug use (adjusted odds ratio [aOR] = 3.4; 95% confidence interval [CI], 1.3-8.5), unsterile tattooing (aOR = 3.4; 95% CI, 1.2-9.9), methamphetamine use (aOR = 2.5; 95% CI, 1.0-6.1), younger age (aOR = 0.7; 95% CI, .5-.9; units = 5 years), and lower adherence to adequately dosed (≥16 mg/day) buprenorphine (aOR = 0.7; 95% CI, .6-1.0; units = 0.25, aOR = 0.3; 95% CI, .1-.9; units = 1.0).
Conclusions: Even with complete MOUD adherence, conferring a 70% protective effect for HCV reinfection, patients reported ongoing risk behaviors. Injection drug use, methamphetamine use, and unsterile tattooing also increase the risk of other bloodborne or skin and soft tissue infections and overdose. Improved health outcomes could be achieved with integrating enhanced monitoring of MOUD with expanded harm reduction including syringe services and contingency management for treatment of stimulant use disorders.
Keywords: harm reduction; hepatitis C; opioid use disorder; people who inject drugs; prison.
© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.