Table 3. Litigation supporting HCV treatment of incarcerated persons that advances hepatitis C elimination through opt-out universal screening and treatment in carceral settings, United States* .

Case	Court	Claims	Rulings
Estelle v. Gamble, 1976	US Supreme Court	Plaintiff was subjected to cruel and unusual punishment in violation of the 8th Amendment for inadequate treatment of a back injury sustained while he was engaged in prison work.	Judge ruled that correctional facilities cannot display deliberate indifference to known healthcare needs of incarcerated individuals.
Stafford v. Carter, 2018	US District Court, Indianapolis Division	98.8% of incarcerated people with chronic HCV infection were withheld DAAs per prison treatment allocation protocol, violating 8th Amendment to the US Constitution, the Americans with Disabilities Act, and the Rehabilitation Act.	Judge ruled that the prison's policy of relying on APRI scores to determine treatment eligibility amounted to deliberate indifference in this class action suit.
Postawko v. Missouri Department of Corrections, 2020	US District Court, Western District of Missouri, Central Division	Class action suit sought prospective relief for denial of rights endowed to plaintiffs by 8th Amendment to the US Constitution and the Americans with Disabilities Act, for systemic denial of treatment for individuals with chronic HCV infection.	Private settlement agreement to enforce universal opt-out screening at intake, perform reflex testing within 3 days of positive antibody result, invest $7 million annually to purchase DAAs and enforce treatment of all individuals at highest risk for complications or disease progression.

*Reflex testing describes the process by which the lab performs HCV antibody testing and, if reactive, uses the same sample to automatically perform HCV RNA testing. APRI, aspartate transaminase to platelet ratio Index; DAA, direct-acting antiviral; HCV, hepatitis C virus.