Background NHS England is committed to eliminating Hepatitis C (HCV) virus infection as a public health problem by 2025. Prisons are a key setting for any elimination strategy due to the high prevalence of infection among prisoners, often due to injecting drug use (IDU). During 2018 we sought to understand barriers and enablers of acceptable HCV care to incarcerated people.
Methods We used a purposive sampling strategy to identify and recruit key stakeholders along the HCV care cascade in English prisons. We interviewed key stakeholders including commissioners, healthcare providers and patient advocates. The semi-structured interviews were recorded, transcribed, and analysed thematically. PHE Research Ethics Group approved the project.
Results Sixteen individuals were interviewed including nurses/doctors (primary and secondary care), commissioners in prisons and community settings, third sector organisations, an ex-incarcerated person, and laboratory personnel. Nine were based in London. Participants identified a number of important barriers. These included: Resource challenges (staffing levels, completing demands), care pathway issues (eg. implementation of testing, high patient turnover, continuity across prisons and to the community, patient nonattendance at clinic, overdependence on a single individual to ensure that the pathway functioned, and lack of reflex HCV RNA testing in laboratories), and patient and staff perceptions (eg. stigma, misunderstanding DAA side effects, cultural issues towards health and HCV). They also identified enablers that included: Providing resources (presence of a designated/paid champion), Senior support including from Governors (allowing stigma, patient attendance and pathway issues to be addressed), Collaboration (between prisons, personnel in prison, and community organisations), Peer to peer education and support, and a Focus on fail-safes in the pathway including effective planning for release or transfer.
Conclusion Prisons could be an important setting for HCV elimination strategies but multiple barriers exist to achieving model care pathways for HCV in prison. This research has identified areas of good practice and important areas for improvement.
Disclosure No significant relationships.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.