Prison officers’ views about hepatitis C testing and treatment: a qualitative enquiry

Jack, Kathryn; Islip, Natalie; Linsley, Paul; Thomson, Brian J.; Patterson, Anne

doi:10.1111/jocn.13489

Cited by 11 publications

(18 citation statements)

References 21 publications

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“…21 These include important organizational issues such as lack of a structured approach to testing, long waiting times, poor linkage to care for those with a positive test, limited knowledge about HCV by prison staff and differing health priorities. 21,22 Our work has overcome many of these barriers.…”

Section: Discussionmentioning

confidence: 99%

Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine

Morey

Hamoodi

Jones³

et al. 2018

Journal of Viral Hepatitis

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Summary With recent advances in antiviral therapy, there is an opportunity to eliminate hepatitis C virus (HCV) from the UK population. HCV is common in incarcerated individuals, with previous estimates suggesting ~7% of the UK prison population is anti‐HCV antibody positive. Increasing diagnosis and treatment of HCV in prison is a priority in seeking to eliminate transmission in the general population. Thus the study aimed to assess the impact implementation of: (a) A universal offer of blood borne virus testing (UOBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; (b) Telemedicine clinics (TC) within North East England (NEE) prisons to increase HCV treatment rates. UOBBVT was initially implemented at Her Majesty's Prison (HMP) Durham, commencing March 2016. From March 2016 to February 2017, 2831 of 4280 (66%) new receptions were offered blood borne virus (BBV) testing. Of these, 1495 (53% of offered) accepted BBV testing, of whom 95 (6.4%) were HCV antibody positive, with 47 of those 95 (49.5%) HCV RNA positive, suggesting a prevalence of active infection in the tested population of 3.1% (95% CI 2.4%‐4.2%). Between August 2015 and October 2017, 80 individuals were seen in the TC and 57 (71%) commenced antiviral therapy. Of those with known outcome (n = 29), 100% achieved sustained virological response. In the year prior to implementation, only four patients received HCV treatment. In conclusion, a universal offer of BBV testing to inmates presenting at HMP reception coupled with linkage into specialist care via TC can substantially increase rates of testing, diagnosis and treatment of HCV in this high‐prevalence population.

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Section: Discussionmentioning

confidence: 99%

Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine

Morey

Hamoodi

Jones³

et al. 2018

Journal of Viral Hepatitis

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“…The observations that out‐reach services impacted negatively on testing rates (which is somewhat counterintuitive), and that undertaking HCV testing on the prison wings may increase uptake (this did not quite achieve statistical significance, P = 0.063) will be explored in a future qualitative publication following interviews with PIP. The former is likely to reflect the established importance of confidentiality within the prison system . Attendance at a clinic known to be specifically set‐up for individuals at risk of HCV infection may lead to social rejection by observant PIP making assumptions about risk behaviours or HCV status, thereby contributing to stigma and creating a barrier to PIP accessing care pathways.…”

Section: Discussionmentioning

confidence: 99%

Testing for hepatitis C virus infection in UK prisons: What actually happens?

Jack

Thomson

Irving

2019

Journal of Viral Hepatitis

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Organization in 2016 1 and given an accelerated target of 2025 in the UK this year. 2 The success of this campaign will depend on a comprehensive and efficient testing process for the diagnosis of HCV in high-risk groups and engagement of infected individuals with viral eradication therapy. The prison population has a higher prevalence of HCV infection than the general community due to the proportion of people in prison (PIP) sentenced for crimes related to the use or distribution of drugs. In support of this, a Health and Justice Report 3 found that during 2014 seropositivity in prisons in the England and Wales estate was 1.5% for hepatitis B virus (HBV), 8% for HCV and 0.6% for human immunodeficiency virus (HIV) and a recent review estimated that 15.4% of PIP in Europe SummaryPrisons are a key demographic in the drive to eradicate hepatitis C virus (HCV) as a major public health threat. We have assessed the impact of the recently introduced national opt-out policy on the current status of HCV testing in 14 prisons in the East Midlands (UK). We analysed testing rates pre-and post-introduction of opt-out testing, together with face-to-face interviews with prison healthcare and management staff in each prison. In the year pre-opt-out, 1972 people in prison (PIP) were tested, compared to 3440 in the year following opt-out. From people were tested, representing 13.5% of all prison entrants (median 16.6%, range 7.6%-40.7%). Factors correlating with testing rates were as follows: pre-admission location of the PIP (another prison or the community, OR 2.2, 95% CI 1.9-2.3, P < 0.001); whether the PIP could access health care independently of prison officers (OR 1.7, 95% CI 1.5-1.8, P < 0.001); the absence of out-reach services for HCV treatment (OR 1.3, 95% CI 1.2-1.5, P < 0.001), whether >50% of PIP reported ease of access to a nurse (OR 2.0, 95% CI 1.8-2.2, P < 0.001), and whether prison health care was supplied by private or NHS providers (OR 1.3, 95% CI 1.2-1.5, P < 0.001). Testing rates remained far below the minimum national opt-out target of 50%. Inadequacy of healthcare facilities and constraints imposed by adherence to prison regimens were cited by healthcare and management staff at all prisons. Without radical change, the prison estate may be intrinsically incapable of supporting NHSE to deliver the HCV elimination strategy. K E Y W O R D Schronic viral hepatitis, diagnostic virology, hepatitis C, prisons

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“…Prison officers were important gatekeepers, as they tended to dictate prisoner movement within the prison environment [44–46, 51, 55]. Prison officers have a challenging role, particularly when budget cuts have strained the workforce (C).…”

Section: Resultsmentioning

confidence: 99%

Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review

Francis-Graham

Ekeke

Nelson

et al. 2019

BMC Health Serv Res

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Background Prisons represent a unique opportunity to diagnose blood-borne viruses. Opt-out testing is receiving increasing interest, as a result of mounting evidence to suggest that the manner in which a test offer is delivered, affects test uptake. Although the effectiveness of opt-out testing within the prison setting has been established, robust explanations are required for the variation in outcomes reported. Methods Rapid-realist review methodology was used to synthesise the literature on prison-based opt-out testing. The review was carried out in three phases. Phase one: An expert panel provided literature relevant to the implementation of opt-out testing within the English prison estate. Unstructured searches were also conducted to identify other social programmes where “opt-out” had been used to increase uptake. Phase two: a systematic search of six peer-review and five grey literature databases was carried out to identify empirical data on opt-out testing within the prison setting. Phase three: Additional non-exhaustive searches were carried out to identify literature that reinforced emergent concepts. The development of programme theory took place with each iteration and was validated in consultation with stakeholders. Results Programme theory was constructed for two outcomes: the proportion of intake offered a test and the proportion offered that accepted testing. The proportion of intake offered testing was influenced by the timing of the test offer, which was often delayed due to barriers to prisoner access. The decision to accept testing was influenced by concerns about confidentiality, fear of a positive diagnosis, a prisoner’s personal interpretation of risk, discomfort with invasive procedures, trust in healthcare, and the fidelity of the opt-out offer. Conclusions This review identified important implementation considerations that moderate the effectiveness of opt-out testing programmes. It also highlighted a lack of appreciation for the theoretical underpinnings of opt-out programmes and tension around how to implement testing in a manner that adheres to both default theory and informed consent. It is anticipated that results will be used to inform the design and implementation of subsequent versions of these programmes, as well as catalyse further in-depth analysis into their operation within the unique context of prison. Review registration CRD42017068342 . Electronic supplementary material The online version of this article (10.1186/s12913-019-3970-z) contains supplementary material, which is available to authorized users.

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Prison officers’ views about hepatitis C testing and treatment: a qualitative enquiry

Cited by 11 publications

References 21 publications

Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine

Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine

Testing for hepatitis C virus infection in UK prisons: What actually happens?

Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review

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