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

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Ceniceros, Paulina Deming, Gaelyn R. D. Archer, Laura E. Tomedi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6529887/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. hepatitis c virus hepatitis c virus treatment New Mexico prison Kaplan-Meier Cox proportional hazards regression Figures Figure 1 Background People who are incarcerated in the United States face a disproportionate burden of hepatitis C virus (HCV) infection, with prevalence estimates nearly nine times higher than in the general population. This disparity reflects structural inequities in healthcare access and continuity, both prior to and during incarceration. In 2018, New Mexico's (NM) prison system reported an HCV antibody (Ab) prevalence of 50.6%, with 62.3% of the HCV Ab population being viremic, one of the highest in the nation 1 . These figures highlight the urgent need for scalable, equitable treatment strategies in correctional settings. Early detection and treatment are essential for preventing disease progression and saving lives. Project ECHO is a tele-mentoring model that incorporates educational didactics and case-based learning to improve access to HCV care in underserved areas. In 2004, the New Mexico Corrections Department (NMCD) partnered with Project ECHO to treat HCV using interferon-based therapies. However, the cost and complexity of interferon-based therapy limited the number of people who could be treated. In 2014, when HCV direct-acting antivirals (DAAs) became available more people were started on treatment; however, rapid DAA scale-up did not occur until 2020 when the NM legislature allocated $ 20 million specifically for HCV treatment within the NMCD. Additionally, the NMCD partnered with the New Mexico Department of Health to procure 340B pricing for DAAs, significantly improving access. ECHO continues to collaborate with the NMCD and their contracted medical provider to update treatment guidelines and expand efforts to address HCV within the state's correctional facilities. This study evaluates the impact of this expansion by examining the time from diagnosis to treatment initiation for incarcerated individuals with HCV in NM following the 2020 scale-up. Understanding treatment timelines in this context can inform strategies to improve care delivery and reduce the burden of HCV among incarcerated populations. Methods In this retrospective cohort study using secondary data, we assessed change in time to treatment in people with HCV viremia entering NM state prisons for the five years that we had complete data for the entire year (2020–2024). Upon entry into the state prison system, everyone with HCV undergo baseline laboratory testing and transient elastography to assess for cirrhosis. The time to treatment was defined as the time in days from a person’s intake into the prison to the time that the person first received treatment for HCV. For people with multiple intake dates or treatment start dates only the first date was used. Year of treatment was categorized based on the initial start of treatment date. Cirrhosis status was determined by the ECHO team after reviewing transient elastography and/or baseline lab work. Gender was determined by the facility that the person was located at time of intake. The ECHO team conducts a weekly review of lab results for all incoming people diagnosed with HCV, ensuring prompt attention to new cases. Additionally, the entire HCV-infected population within the NMCD is reviewed monthly using a master log, a collaborative effort between ECHO and NMCD's medical provider to maintain comprehensive oversight. For those without evidence of cirrhosis or other complicating factors, treatment is administered by NMCD’s medical provider following a simplified treatment algorithm. However, sicker or more complex cases such as patients with cirrhosis or complicated co-morbidities are presented to the ECHO team during weekly ECHO sessions for management and treatment recommendations. This study was IRB approved (#11–544). For this study people without an intake date were excluded from the analysis. Statistical Analysis Among people who were HCV RNA positive (i.e., viremic) at intake and consented to treatment, we assessed days to treatment start date from the initial intake date. The year of treatment was categorized based on the initial treatment date to analyze trends over time. To assess changes in time to treatment, Kaplan-Meier curves were employed to estimate the probability of treatment over time. Log-rank tests and Cox proportional hazards regression were used to determine any significant differences in treatment times across the groups. We adjusted for age, gender, and cirrhosis. These variables were selected a priori. R and R Studio was used for statistical analysis and statistical significance was set to p < 0.05. Results Between November 2020 and December 2024, a total of 2,631 unique individuals entered NMCD, tested positive for HCV upon entry, and received HCV treatment within the NMCD (Table 1 ). The majority of those treated were males, comprising 93% of the group, with most patients being between the ages of 30 and 44 (62%). In 2020, it took approximately 370 days to treat 50% of patients, whereas in 2024 the time for 50% of patients to receive treatment was reduced to just 50 days (Fig. 1 ). In the unadjusted models, time to treatment from 2020 to 2024 was 12.2 times faster (p < 0.001). Time to treatment was 1.2 times faster for females compared to males (p = 0.05), people aged 60 + were 1.3 times faster to receive treatment compared to people aged 18 to < 30 (p = 0.05).. Time to treatment for people with evidence of cirrhosis was 1.3 times faster compared to those without cirrhosis (p = 0.02). When adjusted for age, group, gender, and cirrhosis status, the time to treatment was 12.7 times faster in 2024 compared to 2020 (p < 0.001) (Table 2 ). Table 1 Demographic characteristics by year of treatment start among people who tested positive for HCV RNA and received HCV treatment in New Mexico state prisons, 2020–2024 Variable Category 2020 2021 2022 2023 2024 Total Gender Male 2(3.8%) 38 (8.2%) 56 (8.7%) 60 (6.4%) 40 (7.5%) 196 (7.4%) Female 51(96.2%) 427(91.8%) 591 (91.3%) 874 (93.6%) 492 (92.5%) 2,435 (92.6%) Age Group 18–29 10 (18.9%) 69 (14.8%) 94 (14.5%) 184 (19.7%) 124 (23.3%) 481 (18.3%) 30–44 22 (41.5%) 277 (59.6%) 412 (63.7%) 582 (62.3%) 334 (62.8%) 1,627 (61.8%) 45–59 20 (37.7%) 94 (20.2%) 129 (19.9) 161 (17.2%) 71 (13.3%) 475 (18.1%) 60+ 1 (1.9%) 25 (5.4%) 12 (1.9%) 7 (0.7%) 3 (0.6%) 48 (1.8%) Cirrhotic Status Cirrhotic 5 (9.4%) 36 (7.7%) 25 (3.9%) 24 (2.6%) 26 (4.9%) 116 (4.4%) Non-cirrhotic 48 (90.6%) 429 (92.3%) 622 (96.1%) 910 (97.4%) 506 (95.1%) 2,515 (95.6%) Log-rank test: p-value < 0.001 Table 2 Hazard ratios from cox proportional hazards models among incarcerated people in New Mexico state prisons who tested positive for HCV RNA, 2020–2024 Variable Unadjusted Adjusted n HR 95% CI p-value HR 95% CI p-value Year 2020 53 REF REF 2021 495 1.3 1.0, 1.8 0.05 1.3 1.0, 1.8 0.05 2022 647 2.0 1.5, 2.6 < 0.01 2.0 1.5, 2.6 < 0.001 2023 934 4.7 3.6, 6.3 < 0.01 4.9 3.7, 6.5 < 0.001 2024 532 12.2 9.1, 16.4 < 0.01 12.7 9.4, 17.0 < 0.001 Gender Male 2435 REF Female 196 1.1 0.9, 1.2 0.41 Age Group 18–29 481 REF 30–44 1627 1.0 0.9, 1.1 0.91 45–59 475 1.1 1.0, 1.29 0.06 60+ 48 2.3 1.7, 3.1 < 0.001 Cirrhotic Status Non-cirrhotic 116 REF Cirrhotic 2515 1.1 0.9, 1.3 0.49 Discussion Our analysis shows that time to HCV treatment decreased dramatically after treatment expansion in the NM state prisons. This change persisted and increased after adjustment for characteristics such as age, gender, and cirrhosis status. Initially, the time to initiate HCV treatment within the NMCD was slow, increasing the risk of HCV transmission and potentially worsening liver disease among the population. However, through regular meetings with NMCD, Project ECHO, and NMCD’s contracted medical provider, HCV treatment guidelines were revised to align with the American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidance 2 . This collaboration led to the implementation of a simplified treatment approach that significantly improved the time to treatment. To further enhance treatment efforts, contractual targets were established to incentivize both HCV treatment and care coordination. These efforts likely contributed to reducing the time to start treatment among people in the NM State prisons. Time to treatment could potentially be further be reduced by implementing additional interventions such as RNA point-of-care testing and other assessments 3 . There are several limitations to this assessment. Residual confounding may be present, as we had limited demographic and clinical information on incarcerated individuals, restricting our ability to account for all potential confounders that could influence treatment initiation time. While we adjusted for factors such as age, gender, and cirrhosis status, unmeasured variables, including serious mental health illness, HIV status, race/ethnicity, and opioid use disorder have been found to be significant factors in other studies 4 , and healthcare access before incarceration, could have influenced treatment timing Misclassification and measurement error also pose challenges. Some individuals may have been misclassified regarding their treatment status or HCV infection timeline due to the absence of a standardized electronic health record system, leading to potential errors in tracking time to treatment. Additionally, individuals who tested negative for HCV at intake but later became viremic while incarcerated were not consistently accounted for, resulting in incomplete or inaccurately classified time-to-event data. Moreover, individuals without an intake date were excluded from the time-to-treatment analysis, introducing potential bias by disproportionately omitting individuals with delayed or undetected infections. Biases related to the use of Cox Proportional Hazards (Cox PH) regression should also be considered. Violation of the proportional hazards assumption could lead to biased estimates if the effect of covariates on treatment timing changes over time. If treatment expansion had a time-dependent effect on treatment initiation, standard Cox PH models may not adequately capture this variation. Additionally, immortal time bias may arise if some individuals were classified as untreated during a period when they were not at risk of receiving treatment, artificially inflating survival time in the untreated group. Competing risks bias is also possible, as Cox models do not inherently account for individuals who were released, transferred, or otherwise unable to receive treatment, which could skew estimates of treatment initiation. The onset of COVID-19 likely disrupted the timely initiation of HCV treatment in 2020, complicating efforts to treat HCV in prison populations. Additionally, the contractual targets set by private medical vendors for HCV treatment may have imposed unintended restrictions, limiting the number of individuals eligible for treatment within specific timeframes. Despite these limitations, we were able to launch an HCV treatment expansion project that drastically reduced the time to treatment for thousands of people in NM prisons. Future analyses should incorporate additional confounders, explore alternative strategies to mitigate selection bias, and consider developing proxy intake dates for individuals missing intake data to enhance the accuracy of treatment timing assessments. Additionally, alternative survival analysis methods, such as time-dependent Cox models or competing risks models, should be considered to address potential biases introduced by Cox PH assumptions. Conclusion Universal test-and-treat strategies are essential for reducing HCV transmission and improving health outcomes within carceral settings, where HCV prevalence remains disproportionately high. These programs not only slow disease progression but also demonstrate substantial cost-effectiveness and long-term healthcare savings 5 , 6 , 7 . Prioritizing HCV treatment in prisons is critical to advancing national and global elimination goals while addressing longstanding health disparities among incarcerated populations. This analysis highlights the importance of monitoring time to treatment during periods of rapid DAA scale-up to ensure timely, equitable access to care. Sustained investment, data-driven implementation, and cross-sector collaboration—such as that between the NMCD and Project ECHO—are vital for optimizing HCV care delivery in correctional systems and achieving durable public health impact. Declarations Ethics approval and consent to participate: This study and consent waiver were reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board (IRB #11-544). This study was in accordance with the Declaration of Helsinki. Consent for publication: Not applicable Availability of data and materials: The data that support the findings of this study are not openly available due to the sensitive nature of the data and concerns for privacy and confidentiality. Reasonable requests to the corresponding author can be made with permission from the New Mexico Corrections Department. Competing interests: PD reports a relationship with Gilead Sciences that includes: consulting or advisory. All other authors declare that they have no competing interests. Funding: Not applicable Authors' contributions Juan A. Ceniceros: Conceptualization, Methodology, Formal Analysis, Data Curation, Writing - Original Draft, Writing - Review & Editing, Visualization. Paulina Deming: Conceptualization, Writing - Original Draft, Writing - Review & Editing, Supervision. Gaelyn R. D. Archer: Data curation, Writing - Original Draft, Writing - Review & Editing. Laura E. Tomedi: Methodology, Writing - Original Draft, Writing - Review & Editing, Supervision. Karla Thornton: Conceptualization, Writing - Original Draft, Writing - Review & Editing, Supervision. Acknowledgements: The program described in this manuscript is supported by the New Mexico Corrections Department. Authors' information (optional): Not applicable References Spaulding AC, Chen J, Mackey CA, Adee MG, Bowden CJ, Selvage WD, et al. Assessment and comparison of hepatitis C viremia in the prison systems of New Mexico and Georgia. *JAMA Netw Open*. 2019;2(9):e1910900. doi:10.1001/jamanetworkopen.2019.10900 AASLD-IDSA. HCV guidance: recommendations for testing, managing, and treating hepatitis C [Internet]. Alexandria (VA): AASLD-IDSA; 2023 Dec 19 [cited 2025 Apr 24]. Available from: https://www.hcvguidelines.org/sites/default/files/full-guidance-pdf/AASLD-IDSA_HCVGuidance_December_19_2023.pdf Sheehan Y, Cunningham EB, Cochrane A, et al. A 'one-stop-shop' point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: the PIVOT study. J Hepatol. 2023;79(4):635–644. doi:10.1016/j.jhep.2023.04.019 Chan J, Kaba F, Schwartz J, Bocour A, Akiyama MJ, Rosner Z, Winters A, Yang P, MacDonald R. The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014–2017. EClinicalMedicine. 2020 Oct;27:100567. doi:10.1016/j.eclinm.2020.100567 Fox KC, Somes GW, Waters TM. Timeliness and access to healthcare services via telemedicine for adolescents in state correctional facilities. *J Adolesc Health*. 2007;41(2):161–7. doi:10.1016/j.jadohealth.2007.05.001 Hajarizadeh B, Grebely J, Byrne M, Marks P, Amin J, McManus H, et al. Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study. *Lancet Gastroenterol Hepatol*. 2021;6(7):533–46. doi:10.1016/S2468-1253(21)00077-7 Chhatwal J, Aaron A, Zhong H, Sood N, Irvin R, Alter HJ, et al. Projected health benefits and health care savings from the United States National Hepatitis C Elimination Initiative [Internet]. Cambridge (MA): National Bureau of Economic Research; 2023 Apr 1. Report No.: w31139. Available from: https://doi.org/10.3386/w31139 Additional Declarations Competing interest reported. PD reports a relationship with Gilead Sciences that includes: consulting or advisory. All other authors declare that they have no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6529887","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":462678064,"identity":"b188a5fd-d975-4cc3-8c6f-f3a4f47c37ba","order_by":0,"name":"Juan A. 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D. Archer","email":"","orcid":"","institution":"University of New Mexico","correspondingAuthor":false,"prefix":"","firstName":"Gaelyn","middleName":"R. D.","lastName":"Archer","suffix":""},{"id":462678067,"identity":"99ec68fb-6af8-4196-8d93-ec1ddaec1c7f","order_by":3,"name":"Laura E. 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PD reports a relationship with Gilead Sciences that includes: consulting or advisory. All other authors declare that they have no competing interests.","formattedTitle":"Improvement in time to hepatitis C virus treatment in New Mexico state prisons, 2020-2024","fulltext":[{"header":"Background","content":"\u003cp\u003ePeople who are incarcerated in the United States face a disproportionate burden of hepatitis C virus (HCV) infection, with prevalence estimates nearly nine times higher than in the general population. This disparity reflects structural inequities in healthcare access and continuity, both prior to and during incarceration. In 2018, New Mexico's (NM) prison system reported an HCV antibody (Ab) prevalence of 50.6%, with 62.3% of the HCV Ab population being viremic, one of the highest in the nation\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. These figures highlight the urgent need for scalable, equitable treatment strategies in correctional settings. Early detection and treatment are essential for preventing disease progression and saving lives.\u003c/p\u003e \u003cp\u003eProject ECHO is a tele-mentoring model that incorporates educational didactics and case-based learning to improve access to HCV care in underserved areas. In 2004, the New Mexico Corrections Department (NMCD) partnered with Project ECHO to treat HCV using interferon-based therapies. However, the cost and complexity of interferon-based therapy limited the number of people who could be treated. In 2014, when HCV direct-acting antivirals (DAAs) became available more people were started on treatment; however, rapid DAA scale-up did not occur until 2020 when the NM legislature allocated \u003cspan\u003e$\u003c/span\u003e20\u0026nbsp;million specifically for HCV treatment within the NMCD. Additionally, the NMCD partnered with the New Mexico Department of Health to procure 340B pricing for DAAs, significantly improving access. ECHO continues to collaborate with the NMCD and their contracted medical provider to update treatment guidelines and expand efforts to address HCV within the state's correctional facilities. This study evaluates the impact of this expansion by examining the time from diagnosis to treatment initiation for incarcerated individuals with HCV in NM following the 2020 scale-up. Understanding treatment timelines in this context can inform strategies to improve care delivery and reduce the burden of HCV among incarcerated populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this retrospective cohort study using secondary data, we assessed change in time to treatment in people with HCV viremia entering NM state prisons for the five years that we had complete data for the entire year (2020\u0026ndash;2024). Upon entry into the state prison system, everyone with HCV undergo baseline laboratory testing and transient elastography to assess for cirrhosis. The time to treatment was defined as the time in days from a person\u0026rsquo;s intake into the prison to the time that the person first received treatment for HCV. For people with multiple intake dates or treatment start dates only the first date was used. Year of treatment was categorized based on the initial start of treatment date. Cirrhosis status was determined by the ECHO team after reviewing transient elastography and/or baseline lab work. Gender was determined by the facility that the person was located at time of intake. The ECHO team conducts a weekly review of lab results for all incoming people diagnosed with HCV, ensuring prompt attention to new cases. Additionally, the entire HCV-infected population within the NMCD is reviewed monthly using a master log, a collaborative effort between ECHO and NMCD's medical provider to maintain comprehensive oversight. For those without evidence of cirrhosis or other complicating factors, treatment is administered by NMCD\u0026rsquo;s medical provider following a simplified treatment algorithm. However, sicker or more complex cases such as patients with cirrhosis or complicated co-morbidities are presented to the ECHO team during weekly ECHO sessions for management and treatment recommendations. This study was IRB approved (#11\u0026ndash;544). For this study people without an intake date were excluded from the analysis.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAmong people who were HCV RNA positive (i.e., viremic) at intake and consented to treatment, we assessed days to treatment start date from the initial intake date. The year of treatment was categorized based on the initial treatment date to analyze trends over time. To assess changes in time to treatment, Kaplan-Meier curves were employed to estimate the probability of treatment over time. Log-rank tests and Cox proportional hazards regression were used to determine any significant differences in treatment times across the groups. We adjusted for age, gender, and cirrhosis. These variables were selected a priori. R and R Studio was used for statistical analysis and statistical significance was set to p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBetween November 2020 and December 2024, a total of 2,631 unique individuals entered NMCD, tested positive for HCV upon entry, and received HCV treatment within the NMCD (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of those treated were males, comprising 93% of the group, with most patients being between the ages of 30 and 44 (62%). In 2020, it took approximately 370 days to treat 50% of patients, whereas in 2024 the time for 50% of patients to receive treatment was reduced to just 50 days (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the unadjusted models, time to treatment from 2020 to 2024 was 12.2 times faster (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Time to treatment was 1.2 times faster for females compared to males (p\u0026thinsp;=\u0026thinsp;0.05), people aged 60\u0026thinsp;+\u0026thinsp;were 1.3 times faster to receive treatment compared to people aged 18 to \u0026lt;\u0026thinsp;30 (p\u0026thinsp;=\u0026thinsp;0.05).. Time to treatment for people with evidence of cirrhosis was 1.3 times faster compared to those without cirrhosis (p\u0026thinsp;=\u0026thinsp;0.02). When adjusted for age, group, gender, and cirrhosis status, the time to treatment was 12.7 times faster in 2024 compared to 2020 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics by year of treatment start among people who tested positive for HCV RNA and received HCV treatment in New Mexico state prisons, 2020\u0026ndash;2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e196 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51(96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e427(91.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e591 (91.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e874 (93.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e492 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2,435 (92.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e124 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e481 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e277 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e412 (63.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e582 (62.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e334 (62.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,627 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e129 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e161 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e71 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e475 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e48 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhotic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCirrhotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e26 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e116 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-cirrhotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e429 (92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e622 (96.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e910 (97.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e506 (95.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2,515 (95.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eLog-rank test: p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHazard ratios from cox proportional hazards models among incarcerated people in New Mexico state prisons who tested positive for HCV RNA, 2020\u0026ndash;2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0, 1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.0, 1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5, 2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.5, 2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.6, 6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.7, 6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.1, 16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9.4, 17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.9, 1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.9, 1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.0, 1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.7, 3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhotic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-cirrhotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.9, 1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur analysis shows that time to HCV treatment decreased dramatically after treatment expansion in the NM state prisons. This change persisted and increased after adjustment for characteristics such as age, gender, and cirrhosis status.\u003c/p\u003e \u003cp\u003eInitially, the time to initiate HCV treatment within the NMCD was slow, increasing the risk of HCV transmission and potentially worsening liver disease among the population. However, through regular meetings with NMCD, Project ECHO, and NMCD\u0026rsquo;s contracted medical provider, HCV treatment guidelines were revised to align with the American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidance\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. This collaboration led to the implementation of a simplified treatment approach that significantly improved the time to treatment. To further enhance treatment efforts, contractual targets were established to incentivize both HCV treatment and care coordination. These efforts likely contributed to reducing the time to start treatment among people in the NM State prisons. Time to treatment could potentially be further be reduced by implementing additional interventions such as RNA point-of-care testing and other assessments\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere are several limitations to this assessment. Residual confounding may be present, as we had limited demographic and clinical information on incarcerated individuals, restricting our ability to account for all potential confounders that could influence treatment initiation time. While we adjusted for factors such as age, gender, and cirrhosis status, unmeasured variables, including serious mental health illness, HIV status, race/ethnicity, and opioid use disorder have been found to be significant factors in other studies\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, and healthcare access before incarceration, could have influenced treatment timing Misclassification and measurement error also pose challenges. Some individuals may have been misclassified regarding their treatment status or HCV infection timeline due to the absence of a standardized electronic health record system, leading to potential errors in tracking time to treatment. Additionally, individuals who tested negative for HCV at intake but later became viremic while incarcerated were not consistently accounted for, resulting in incomplete or inaccurately classified time-to-event data. Moreover, individuals without an intake date were excluded from the time-to-treatment analysis, introducing potential bias by disproportionately omitting individuals with delayed or undetected infections.\u003c/p\u003e \u003cp\u003eBiases related to the use of Cox Proportional Hazards (Cox PH) regression should also be considered. Violation of the proportional hazards assumption could lead to biased estimates if the effect of covariates on treatment timing changes over time. If treatment expansion had a time-dependent effect on treatment initiation, standard Cox PH models may not adequately capture this variation. Additionally, immortal time bias may arise if some individuals were classified as untreated during a period when they were not at risk of receiving treatment, artificially inflating survival time in the untreated group. Competing risks bias is also possible, as Cox models do not inherently account for individuals who were released, transferred, or otherwise unable to receive treatment, which could skew estimates of treatment initiation.\u003c/p\u003e \u003cp\u003eThe onset of COVID-19 likely disrupted the timely initiation of HCV treatment in 2020, complicating efforts to treat HCV in prison populations. Additionally, the contractual targets set by private medical vendors for HCV treatment may have imposed unintended restrictions, limiting the number of individuals eligible for treatment within specific timeframes. Despite these limitations, we were able to launch an HCV treatment expansion project that drastically reduced the time to treatment for thousands of people in NM prisons. Future analyses should incorporate additional confounders, explore alternative strategies to mitigate selection bias, and consider developing proxy intake dates for individuals missing intake data to enhance the accuracy of treatment timing assessments. Additionally, alternative survival analysis methods, such as time-dependent Cox models or competing risks models, should be considered to address potential biases introduced by Cox PH assumptions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUniversal test-and-treat strategies are essential for reducing HCV transmission and improving health outcomes within carceral settings, where HCV prevalence remains disproportionately high. These programs not only slow disease progression but also demonstrate substantial cost-effectiveness and long-term healthcare savings\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Prioritizing HCV treatment in prisons is critical to advancing national and global elimination goals while addressing longstanding health disparities among incarcerated populations.\u003c/p\u003e \u003cp\u003eThis analysis highlights the importance of monitoring time to treatment during periods of rapid DAA scale-up to ensure timely, equitable access to care. Sustained investment, data-driven implementation, and cross-sector collaboration\u0026mdash;such as that between the NMCD and Project ECHO\u0026mdash;are vital for optimizing HCV care delivery in correctional systems and achieving durable public health impact.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis study and consent waiver were reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board (IRB #11-544). This study was in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to the sensitive nature of the data and concerns for privacy and confidentiality. Reasonable requests to the corresponding author can be made with permission from the New Mexico Corrections Department.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003ePD reports a relationship with Gilead Sciences that includes: consulting or advisory. All other authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eJuan A. Ceniceros: Conceptualization, Methodology, Formal Analysis, Data Curation, Writing - Original Draft, Writing - Review \u0026amp; Editing, Visualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePaulina Deming: Conceptualization, Writing - Original Draft, Writing - Review \u0026amp; Editing, Supervision. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGaelyn R. D. Archer: Data curation, Writing - Original Draft, Writing - Review \u0026amp; Editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLaura E. Tomedi: Methodology, Writing - Original Draft, Writing - Review \u0026amp; Editing, Supervision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKarla Thornton: Conceptualization, Writing - Original Draft, Writing - Review \u0026amp; Editing, Supervision.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eThe program described in this manuscript is supported by the New Mexico Corrections Department.\u003c/p\u003e\n\u003cp\u003eAuthors' information (optional):\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSpaulding AC, Chen J, Mackey CA, Adee MG, Bowden CJ, Selvage WD, et al. Assessment and comparison of hepatitis C viremia in the prison systems of New Mexico and Georgia. *JAMA Netw Open*. 2019;2(9):e1910900. doi:10.1001/jamanetworkopen.2019.10900\u003c/li\u003e\n\u003cli\u003eAASLD-IDSA. HCV guidance: recommendations for testing, managing, and treating hepatitis C [Internet]. Alexandria (VA): AASLD-IDSA; 2023 Dec 19 [cited 2025 Apr 24]. Available from: https://www.hcvguidelines.org/sites/default/files/full-guidance-pdf/AASLD-IDSA_HCVGuidance_December_19_2023.pdf\u003c/li\u003e\n\u003cli\u003eSheehan Y, Cunningham EB, Cochrane A, et al. A \u0026apos;one-stop-shop\u0026apos; point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: the PIVOT study. J Hepatol. 2023;79(4):635\u0026ndash;644. doi:10.1016/j.jhep.2023.04.019\u003c/li\u003e\n\u003cli\u003eChan J, Kaba F, Schwartz J, Bocour A, Akiyama MJ, Rosner Z, Winters A, Yang P, MacDonald R. The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014\u0026ndash;2017. EClinicalMedicine. 2020 Oct;27:100567. doi:10.1016/j.eclinm.2020.100567\u003c/li\u003e\n\u003cli\u003eFox KC, Somes GW, Waters TM. Timeliness and access to healthcare services via telemedicine for adolescents in state correctional facilities. *J Adolesc Health*. 2007;41(2):161\u0026ndash;7. doi:10.1016/j.jadohealth.2007.05.001\u003c/li\u003e\n\u003cli\u003eHajarizadeh B, Grebely J, Byrne M, Marks P, Amin J, McManus H, et al. Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study. *Lancet Gastroenterol Hepatol*. 2021;6(7):533\u0026ndash;46. doi:10.1016/S2468-1253(21)00077-7\u003c/li\u003e\n\u003cli\u003eChhatwal J, Aaron A, Zhong H, Sood N, Irvin R, Alter HJ, et al. Projected health benefits and health care savings from the United States National Hepatitis C Elimination Initiative [Internet]. Cambridge (MA): National Bureau of Economic Research; 2023 Apr 1. Report No.: w31139. Available from: https://doi.org/10.3386/w31139\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hepatitis c virus, hepatitis c virus treatment, New Mexico, prison, Kaplan-Meier, Cox proportional hazards regression","lastPublishedDoi":"10.21203/rs.3.rs-6529887/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6529887/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNew 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\u0026rsquo;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\u0026rsquo;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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTime 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFor 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\u0026ndash;44 (61.8%), and male (92.6%). Overall, time to treatment was 12.7 times faster in 2024 compared to 2020 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) when adjusted by age group, gender, and cirrhosis status.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTime 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.\u003c/p\u003e","manuscriptTitle":"Improvement in time to hepatitis C virus treatment in New Mexico state prisons, 2020-2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-28 15:54:12","doi":"10.21203/rs.3.rs-6529887/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"951dfcb9-0028-405c-a21d-932cac652e88","owner":[],"postedDate":"May 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-26T04:23:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-28 15:54:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6529887","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6529887","identity":"rs-6529887","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}