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. 2019 Nov 14;9:16849. doi: 10.1038/s41598-019-52564-0

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Model schematic showing the prison population and general population and the dynamic movement between the two groups (dashed arrows). Individuals are defined by demographic characteristics, liver disease stage, and injection drug use (IDU) status. Throughout the simulation, several characteristics are updated: age, IDU status, HCV infection status (infected individuals shown in blue), liver disease stage, and location (inside or outside prison). HCV-infected individuals can transmit disease to others in their immediate network (solid arrows). The natural history of chronic HCV disease is represented by Markov states (top right inset). Stages of chronic HCV disease are defined by METAVIR fibrosis scores. Advanced liver diseases stages are DC, HCC, LT, and LRDs. DC = decompensated cirrhosis; F0 = no fibrosis; F1 = portal fibrosis without septa; F2 = portal fibrosis with few septa; F3 = numerous septa without cirrhosis; F4 = compensated cirrhosis; HCC = hepatocellular carcinoma; HCV = hepatitis C virus; IDU = injection drug use; LRD = liver-related death; LT = liver transplantation.