Learning from Civil Rights Lawsuits: A White Paper Series

White Paper: Policies for Expanding Hepatitis C Testing and Treatment in United States Prisons and Jails

By: Tessa Bialek, Managing Attorney, Civil Rights Litigation Clearinghouse & Matthew J. Akiyama, M.D., M.Sc., Associate Professor, Department of Medicine, Divisions of General Internal Medicine and Infectious Disease, Montefiore Medical Center and Albert Einstein College of Medicine

April 19, 2023

This project proposes model policies for scaling up Hepatitis C virus (HCV) testing and treatment in United States prisons and jails. It also collects and makes available litigation documents and other materials related to HCV testing and treatment in prisons and jails, including: settlement agreements; judicial opinions; expert and monitor reports; and existing HCV policies.

A person in an orange top reaches their hand toward a person in a white coat, with a stethoscope and blue gloves, who is holding a blister pack of medication.


White Paper Summary

Hepatitis C virus (HCV) is highly prevalent in United States prisons and jails, where rates of infection are 10 to 20 times greater than national levels and where more than 30% of all people living with HCV in the United States will spend time in any given year. Rates are especially high among people who inject drugs (PWID), a population whose members are also likely to move between correctional settings and the community. Addressing HCV among incarcerated populations could therefore have a significant effect on transmission of the virus both inside and outside of confinement. Safe and effective HCV treatment is now possible with direct acting antivirals (DAAs), but access in confinement remains limited. Widespread HCV testing and DAA treatment in prisons, and widespread testing and treatment or linkage to community care in jails, would align with existing medical guidance and ensure compliance with federal law, and is an essential public health approach. 

The Clearinghouse Special Collection “Hepatitis C Treatment in Jails and Prisons,” available here, gathers cases addressing HCV testing and treatment in jails and prisons, with particular focus on litigation seeking to increase access to DAAs.

Our white paper, Policies for Expanding Hepatitis C Testing and Treatment in United States Prisons and Jails, draws lessons from the cases in that collection, as well as from interviews and workshops with advocates, medical professionals, and others with expertise on this topic. The paper proposes policies for scaling up HCV testing, evaluating and monitoring the disease, universalizing access to direct acting antiviral medication, and supporting successful treatment outcomes. The model policies are intended as a template for correctional administrators, medical staff and contractors, and advocates who are working to change jail and prison policy. We have written them so that they can be easily copied, pasted, and adapted for a particular facility or system.

Project resources include: 

  • White Paper: Policies for Expanding Hepatitis C Testing and Treatment in United States Prisons and Jails (screen-readable regular size version and large print version)
  • Google Drive Folder: Expanding HCV Testing and Treatment in US Prisons and Jails, available here, containing:
    • The model policies in (unfootnoted) word processing format, to facilitate copying, pasting, and modifying to a particular system or facility.
    • State department of corrections policies cited in the white paper.  


By: Tessa Bialek and Matthew J. Akiyama, M.D., M.Sc.

April 19, 2023

This white paper proposes policies for expanding access to Hepatitis C (HCV) testing and treatment in United States jails and prisons. In recent years, dozens of lawsuits across the country have sought expanded access to direct acting antiviral treatment in carceral settings. The white paper's policy recommendations draw principally from settlement agreements, judicial opinions, and other filings in those cases, supplemented by current medical guidance and input from public health experts, medical professionals, and advocates. The white paper proceeds in three parts. First, it describes the HCV epidemic in United States prisons and jails and current clinical guidance and public health recommendations. Next, the paper sets out the governing legal landscape. Finally, it offers model policies for prisons and jails to expand HCV testing and treatment and to support successful outcomes.

This version of the white paper is screen readable. A large print (but not screen readable) version of the white paper is available here. The white paper project and related resources, including links to cases in the accompanying special collection and collected policy documents, are here. A version of this white paper is forthcoming in Volume 57 of the University of Michigan Journal of Law Reform.

By: Civil Rights Litigation Clearinghouse

March 15, 2023

This is a Google Drive folder containing:

  • An unfootnoted version of the model policies in Part III of our white paper Policies for Expanding HCV Testing and Treatment in United States Jails and Prisons; this omits all the commentary and footnotes, for ease of copying, pasting, and adapting.
  • A sample of relevant DOC policies from states across the country, including all such policies referenced in the white paper, up to date as of 2023.

(Note: The full Clearinghouse project page, including the white paper, is here.)

June 23, 2023

A webinar and slides from a recent presentation on Medicaid waiver opportunities for covering viral hepatitis and other reentry services in jails and prisons, presented by the National Viral Hepatitis Roundtable and featuring Kinda Serafi, Partner, Manatt, Phelps & Phillips, LLP.