A ‘one-stop-shop’ point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: The PIVOT study

Sheehan, Yumi; Cunningham, Evan B; Cochrane, Amanda; Byrne, Marianne; Brown, Tracey; McGrath, Colette; Lafferty, Lise; Tedla, Nicodemus; Dore, Greg; Lloyd, Andrew R.; Grebely, Jason

doi:10.1016/j.jhep.2023.04.019

Cited by 22 publications

(10 citation statements)

References 36 publications

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“…Similarly, an Australian study reported high test uptake and shortened transition to treatment among a cohort screened on reception using a one-stop approach including PoC RNA testing with additional fast-track components. Initial results indicated that those tested by PoC had shorter time from testing to treatment (6 ver 90 days; p<0.001) as well as high treatment uptake, similar to our findings 37. Although views of imprisoned people on the acceptability of PoC testing did not form part of the work undertaken here, other studies have examined this.…”

Section: Discussionsupporting

confidence: 83%

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

et al. 2023

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ObjectivesHepatitis C virus (HCV) poses a global public health threat. Prisons are a focus of prevention efforts due to high infection burdens. Expedition of treatment for incarcerated people is critical, as many are short-term sentenced. We evaluated point-of-care (PoC) HCV RNA testing in a maximum-security Scottish prison and assessed its impact on transition to treatment. We also evaluated costs and determinants of implementation.DesignMixed-methods evaluation of a single-centre care pathway pilot using National Health Service (NHS) data from 2018 to 2021. Descriptive statistics and survival analysis were undertaken. Cost analysis was assessed from a provider perspective. Healthcare staff participated in semistructured interviews and thematic analysis with a deductive approach was undertaken to identify implementation determinants.SettingA large maximum-security Scottish prison health centre administered by the NHS.Participants296 incarcerated NHS patients (all men) and six NHS staff members (two men and four women).InterventionsHCV testing using the Cepheid GeneXpert platform with Xpert HCV VL Fingerstick assay.Outcome measuresThe main outcome was survival (in days) from HCV test to treatment initiation. Secondary outcomes were cost-per-cure obtained and implementation determinants.ResultsDuring the pilot, 167 Xpert tests were administered, with an 84% completion rate, and treatment transition was superior for those who received it (p=0.014). Where PoC tests were administered, shorter survival to treatment was observed (19 vs 33 days: adjusted HR (aHR) 1.91 (1.03–3.55), p=0.040; 19 vs 50 days; aHR 3.76 (1.67–8.46), p=0.001). PoC was costlier than conventional testing. In qualitative analysis, most facilitators were observed among characteristics of individual domain while most barriers were noted in the inner setting.ConclusionsIntegrating PoC HCV RNA diagnosis into nurse-led HCV care in a maximum-security prison health centre shortens survival to HCV treatment. However, there are cost implications to this approach and multiple determinants that impact on implementation should be addressed.

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Section: Discussionsupporting

confidence: 83%

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

et al. 2023

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“…This method has been shown to increase antiviral treatment uptake and reduce time to treatment initiation. 27,28 Our study does have some limitations. First, our cohort included 150 individuals who tested positive for HCV but were rapidly transferred out of our region, thus we do not have information on their treatment status.…”

Section: Discussionmentioning

confidence: 94%

“…To address this, we plan to introduce a point of care HCV‐RNA test at reception for individuals known to be HCV‐Ab positive, to speed up the time to diagnosis of HCV viraemia, which will hopefully translate into higher rates of treatment initiation. This method has been shown to increase antiviral treatment uptake and reduce time to treatment initiation 27,28 …”

Section: Discussionmentioning

confidence: 99%

Impact of 5 years of hepatitis C testing and treatment in the North East of England prisons

Johnson,

Shearer,

Thompson

et al. 2023

Journal of Viral Hepatitis

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Hepatitis C virus infection (HCV) is prevalent in prisons. Therefore, effective prison HCV services are critical for HCV elimination programmes. We aimed to evaluate the efficacy of a regional HCV prison testing and treatment programme. Between July 2017 and June 2022, data were collected prospectively on HCV test offer and uptake rates, HCV Antibody (HCV‐Ab) and HCV‐RNA positivity, treatment starts and outcomes for new inmates incarcerated in three prisons. Rates of HCV‐Ab and RNA positivity at reception, incidence of new HCV infections and reinfection following treatment were determined. From a total of 39,652 receptions, 33,028 (83.3%) were offered HCV testing and 20,394 (61.7%) completed testing. Including all receptions, 24.5% of tests (n = 4995) were HCV‐Ab positive and 8.4% of tests (n = 1713) were HCV‐RNA positive. When considering the first test for each individual (median age 34 years; 88.1% male), 14.8% (n = 1869) and 7.2% (n = 905) were HCV‐Ab and HCV‐RNA positive, respectively. The incidence of new HCV‐Ab and RNA positivity was 5.1 and 3.3 per 100 person‐years, respectively. Of 1145 HCV viraemic individuals, 18 died within 6 months and 150 were rapidly transferred out of area, leaving 977 individuals with outcomes. Of these, 835 (85.5%) received antivirals and 47 spontaneously cleared the infection, leaving 95 (9.7%) untreated. 607 (72.7%) achieved SVR. 95 patients had reinfection post‐treatment (rate 10.1 cases per 100 person‐years). Testing for HCV has increased in our prisons and the majority with viraemia are initiated on antiviral treatment. Reassuringly, a significant fall in frequency of HCV‐RNA positivity at prison reception was observed suggesting progress towards HCV elimination.

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“…Navigation of services refers to ‘the capacity to reach appropriate services’ and requires ‘an awareness of the suitable sources of care’ [24] (p. 14). Short incarceration periods can inhibit HCV care engagement via traditional testing pathways because of the often lengthy (several weeks) wait for pathology results [19]. Participants identified some of the systemic barriers to HCV care engagement in the prison setting via standard care, particularly the disrupted care cascade resulting from transfers within the prison system and release to freedom (sometimes resulting in a cycle of re‐identification of patient candidacy).…”

Section: Resultsmentioning

confidence: 99%

“…Point‐of‐care HCV testing has been gaining momentum as a timely diagnostic tool in the prison setting. This technology has been used in prisons in several countries, including Australia [19], Canada [20], England [18], Iran [21] and Thailand [22]. However, most of these examples use point‐of‐care antibody testing with provision of reflexive RNA testing.…”

Section: Introductionmentioning

confidence: 99%

Reducing barriers to the hepatitis C care cascade in prison via point‐of‐care RNA testing: a qualitative exploration of men in prison using an integrated framework

et al. 2023

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Background and Aims Hepatitis C virus (HCV) is highly prevalent within the prison setting. Although HCV testing and treatment are available within prisons, system barriers can impede progress along the HCV care cascade for those who are incarcerated. The PIVOT intervention used a ‘one‐stop‐shop‘ model (i.e. point‐of‐care HCV RNA testing, Fibroscan‐based liver disease assessment and treatment) at a reception prison in New South Wales, Australia. This analysis sought to understand the role of point‐of‐care HCV RNA testing at intake in reducing barriers to the HCV care cascade within the male prison setting. Design and Setting Qualitative analysis using semi‐structured interviews in a reception prison in Australia. Participants Twenty‐four men enrolled in the PIVOT study; all participants had undergone HCV point‐of‐care testing in the intervention arm. Measurements Høj's Integrated Framework informed this analysis. Findings Participants widely expressed the view that point‐of‐care HCV RNA testing on entry was beneficial for care engagement. Point‐of‐care testing was perceived as timely (compared with standard pathology) and reduced opportunities for adjudication by correctional officers due to fewer clinic visits for testing and results. Adoption of routine opt‐out testing at prison intake was regarded as an important strategy for normalising HCV testing (and likely to increase pathways to treatment uptake) and fostered patient candidacy (i.e. self‐perceived eligibility to access care). Conclusion Twenty‐four men in prison in New South Wales, Australia, who underwent opt‐out point‐of‐care HCV RNA testing on entry into prison, widely supported the programme as a means of overcoming barriers to HCV testing and treatment in the prison setting, as well as providing public health benefits through early detection of HCV infection among people entering into custody.

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A ‘one-stop-shop’ point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: The PIVOT study

Cited by 22 publications

References 36 publications

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

Impact of 5 years of hepatitis C testing and treatment in the North East of England prisons

Reducing barriers to the hepatitis C care cascade in prison via point‐of‐care RNA testing: a qualitative exploration of men in prison using an integrated framework

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