by Beth Duff-Brown,Stanford University

Credit: Unsplash/CC0 Public Domain

A Stanford study shows that jail-based hepatitis C programs could cut new infections by nearly half among people who inject drugs, potentially providing a major boost to lagging U.S. efforts to meet national hepatitis C elimination goals.

The study, published inJAMA Internal Medicine,modeled how hepatitis C spreads through networks of people who inject drugs as they move between jails and communities. Results showed that a combination of testing people when they enter jail, starting treatment in jail, and connecting them to care after release could reduce new infections by 47% and deaths by 40% in this population.

The approach would cost about$11,000for each year of healthy life gained, well within the range that public health experts consider good value for money.

The study was a collaboration between researchers at Stanford's Prevention Policy Modeling Lab and public health experts at the Centers for Disease Control and Prevention, the Philadelphia Department of Public Health, Philadelphia Department of Prisons, and Philadelphia FIGHT, a health services organization that provides HCV testing and treatment in jails and coordinates post-release services with local health care organizations and jails.

"The U.S. set a goal to reduce hepatitis C infections by 90% and deaths by 65% by 2030, but we're not on track," said Lin Zhu, Ph.D., lead author of the study and a senior research engineer at Stanford Health Policy when the research was conducted.

"Our findings suggest that jails, which serve a population with far higher hepatitis C rates than the general public, could be a critical but underused intervention point."

Since 2011, new hepatitis C cases have been rising, with around 2.2 million people living with chronic infection. Most new infections occur through injection drug use, and people who inject drugs are more likely to spend time in jail, which makes this setting an important venue for prevention efforts.

Modeling real-world programs

The researchers used simulation modeling to project long-term outcomes for networks of people who inject drugs, tracking how hepatitis C spreads through sharing of injecting equipment among individuals cycling between jails and community settings.

"Factors includinglack of health insurance, housing instability, and criminalization and stigmatization of drug use create barriers to health care access and utilization among people who inject drugs, highlighting the need for innovative strategies to engage this group," said Zhu, now an assistant professor at the University of Miami Miller School of Medicine.

The team modeled four intervention strategies based on published data from the Philadelphia FIGHT program:

Each simulated scenario also included ongoing community programs such as hepatitis C testing and treatment, syringe services, and medication for opioid use disorder.

Substantial impact and value

The simulation predicted that without jail-based interventions, there would be 21,000 person-years lived with hepatitis C infection (a measure combining the number of people infected with the duration of infection), 662 new infections, and 240 hepatitis C-related deaths per 1,000 people who inject drugs over a 60-year period.

The combined strategy of testing on entry, treatment in jail, and post-release support showed the greatest impact: a 35% reduction in time lived with infection; a 47% reduction in new infections; and a 40% reduction in hepatitis C-related deaths.

The results showed that providing treatment in jail was cost-saving or had substantially improved cost-effectiveness compared with testing alone. Additionally, offering navigation services on release consistently improved both health outcomes and economic value across strategies.

"Despite restricted jail budgets, these programs forhepatitis Coffer substantial health benefits and economic value when integrated into broader public health funding frameworks," said Joshua Salomon, Ph.D., professor of health policy at Stanford Medicine and senior author of the study.

"Currently, few large jails have the capacity and funding to implement hepatitis C programs. If adequately resourced, extending these interventions to large and medium-sized jails could accelerate progress toward hepatitis C elimination."

In anaccompanying commentary, Benjamin A. Howell, MD, MPH, MHS, of Yale School of Medicine, and Byron S. Kennedy, MD, Ph.D., MPH, of the Connecticut Department of Correction, emphasized that while the study demonstrates impact and cost-effectiveness, "implementing these programs should align with broader efforts to identify interventions that reach this population before contact with the criminal justice system."

Publication details Lin Zhu et al, Health Benefits, Costs, and Cost-Effectiveness of Jail-Based Hepatitis C Elimination Strategies, JAMA Internal Medicine (2026). DOI: 10.1001/jamainternmed.2026.0190 Benjamin A. Howell et al, Treating Chronic HCV Infections in Jail Is Feasible and Cost-Effective—What Now?, JAMA Internal Medicine (2026). DOI: 10.1001/jamainternmed.2026.0187 Journal information: JAMA Internal Medicine