'I just keep thinking I haven't got it because I'm not yellow': a qualitative study of the factors that influence the uptake of Hepatitis C testing by prisoners

Abstract

BackgroundHepatitis C viral (HCV) infection is a significant public health problem. In the UK, an estimated 200,000 individuals have active HCV infection, most of whom are injecting drug users (IDUs). Many IDUs spend time within the prison system therefore screening for HCV infection in this setting is important. However, uptake of testing within prisons is very low.MethodsQualitative interview study. 30 interviews with 25 male and 5 female prisoners with a history of injecting drug use.ResultsPersonal and institutional barriers to uptake of testing for HCV were identified. Personal barriers included: prisoners' fears and lack of knowledge about HCV, low motivation for testing, lack of awareness about the testing procedure, and concerns about confidentiality and stigma. Institutional barriers included: the prisons' applications procedure for testing, inadequate pre- and post-test discussion, lack of pro-active approaches to offering testing, and lack of continuity of care on discharge and transfer.ConclusionThis study highlights potential areas of development in the management of HCV in prisons. Further research is needed to evaluate care pathways for HCV in the prison setting and to develop and assess interventions to improve the uptake of testing for HCV by prisoners.

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

“…The majority of studies included people who had acquired, or were at risk of acquiring, infection though injecting drug use; one of which focused on people in, or recently released from, prison (Khaw, Stobbart, & Murtagh, 2007). Two studies included the views of health professionals involved in the care of PWIDs; one as the sole study participants (Perry & Chew-Graham, 2003) and one, in addition to the views and experiences of PWID (Munoz-Plaza, Strauss, Astone, Jarlms, & Hagan, 2004).…”

“…However, there were exceptions, with studies noting that the extent to which PWID participated in the 'normalised discourse' was influenced by their situation, social context and personal relationships (Wozniak et al, 2007;Roy et al, 2007;Harris, 2009b). While PWID were motivated by concerns that they may have acquired HCV through injecting and the belief that HCV was an expected consequence of injecting drug use (Khaw et al, 2007;Roy et al, 2007;Swan et al, 9 2010; Temple-Smith et al, 2004;Wozniak et al, 2007) there was also evidence that PWID perceived themselves to be at low risk of infection related to a belief in the minimisation of infection risk within their injecting network (Gyarmarthy et al, 2006). In a UK study (Perry & Chew-Graham, 2003) of GP's experiences of HCV testing, denial of possible infection among PWID was viewed as a barrier to the informed consent process and therefore testing.…”

“…For those with concerns about a positive diagnosis, anxiety over the impact of HCV on the chances of finding a long term partner, sexual relations, starting a family and the possibility of transmission predominated (Carrier et al, 2005;Harris, 2009b;Temple-Smith et al, 2004;Tompkins et al, 2005;. A positive diagnosis led some 10 PWID to re-evaluate their lives and make the first steps towards a life away from their drug use (Roy et al, 2007;Sutton & Treloar, 2007;Swan et al, 2010) or towards adopting a healthier lifestyle, such as eating more healthily and reducing alcohol and drug use (Cullen et al, 2005;Faye & Irurita, 2003;Khaw et al, 2007;Roy et al, 2007;Sutton & Treloar, 2007;Wozniak et al, 2007;Wright et al, 2005).…”

“…A diagnosis of HCV (Harris, 2009b;Roy et al, 2007) was not viewed as overly concerning as there was a perception of HCV as a health condition that developed over many years; as such HCV was viewed as inconsequential relative to other disruptions, for example, a drugs overdose. However, injecting behaviour was also a motivation for testing with PWID citing social or personal responsibility to others, such as those within their injecting networks (Craine et al, 2004;Khaw et al, 2007;Roy et al, 2007). For those with concerns about a positive diagnosis, anxiety over the impact of HCV on the chances of finding a long term partner, sexual relations, starting a family and the possibility of transmission predominated (Carrier et al, 2005;Harris, 2009b;Temple-Smith et al, 2004;Tompkins et al, 2005;.…”

“…) Experiences of being informed on the outcome of testing were generally poor. Many PWID remained unclear about the meaning of a diagnosis and experienced limited and inadequate information provision by health professionals, leading to substantial gaps in knowledge (Copeland, 2004;Cullen, Kelly, Stanley, Langton, & Bury, 2005;Faye & Irurita, 2003;Khaw et al, 2007;Lally et al, 2008;Rhodes et al, 2004;Southgate et al, 2005;Strauss et al, 2008;Sutton & Treloar, 2007;Swan et al, 2010;Temple-Smith, Gifford, & Stoové, 2004;Tompkins et al, 2005). A policy of not informing 8 PWID of the outcomes of testing ("a no news is good news approach"), as described in two drugs services , also produced anxiety.…”