Barriers and facilitators to hepatitis C (HCV) screening and treatment\u2014a description of prisoners\u2019 perspective

Des Crowley,Carol Murphy,Walter Cullen,Marie Claire Van Hout,Enda Kelly,John S Lambert

doi:10.1186/s12954-018-0269-z

Abstract

BackgroundHepatitis C virus (HCV) infection is a global epidemic with an estimated 71 million people infected worldwide. People who inject drugs (PWID) are overrepresented in prison populations globally and have higher levels of HCV infection than the general population. Despite increased access to primary health care while in prison, many HCV infected prisoners do not engage with screening or treatment. With recent advances in treatment regimes, HCV in now a curable and preventable disease and prisons provide an ideal opportunity to engage this hard to reach population.AimTo identify barriers and enablers to HCV screening and treatment in prisons.MethodsA qualitative study of four prisoner focus groups (n = 46) conducted at two prison settings in Dublin, Ireland.ResultsThe following barriers to HCV screening and treatment were identified: lack of knowledge, concerns regarding confidentiality and stigma experienced and inconsistent and delayed access to prison health services. Enablers identified included; access to health care, opt-out screening at committal, peer support, and stability of prison life which removed many of the competing priorities associated with life on the outside. Unique blocks and enablers to HCV treatment reported were fear of treatment and having a liver biopsy, the requirement to go to hospital and in-reach hepatology services and fibroscanning.ConclusionThe many barriers and enablers to HCV screening and treatment reported by Irish prisoners will inform both national and international public health HCV elimination strategies. Incarceration provides a unique opportunity to upscale HCV treatment and linkage to the community would support effectiveness.

Highlights

Hepatitis C infection (HCV) is a major global epidemic, with an estimated 71 million people chronically infected worldwide [1]
The many barriers and enablers to Hepatitis C virus (HCV) screening and treatment reported by Irish prisoners will inform both national and international public health HCV elimination strategies
The following themes related to barriers to both HCV screening and treatment emerged from the analysis, lack of knowledge, concerns regarding confidentiality, fear of being stigmatised, inconsistent access to prison health services with delays in screening and receiving results

Summary

Introduction

Hepatitis C infection (HCV) is a major global epidemic, with an estimated 71 million people chronically infected worldwide [1]. The global HCV prevalence in incarcerated populations is estimated at 26%, increasing to 64% among those with a history of IDU [3]. Prisoners have better access to primary health care and lower mortality than when released back into the community [9, 11]. Hepatitis C virus (HCV) infection is a global epidemic with an estimated 71 million people infected worldwide. People who inject drugs (PWID) are overrepresented in prison populations globally and have higher levels of HCV infection than the general population. Despite increased access to primary health care while in prison, many HCV infected prisoners do not engage with screening or treatment. With recent advances in treatment regimes, HCV in a curable and preventable disease and prisons provide an ideal opportunity to engage this hard to reach population

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Conclusion