Hepatitis C treatment as prevention in the prison setting: Assessments of acceptability of treatment scale up efforts by prison correctional and health personnel.

Abstract

Hepatitis C (HCV) infection is prevalent in the prison setting, with sharing of unsterile injecting equipment the most common mode of transmission in high income countries. Mathematical modelling suggests that HCV treatment scale-up could prevent onward transmission, known as treatment as prevention. Direct-acting antivirals have enabled rapid scale up of HCV treatment, underpinning the first clinical trial of treatment as prevention in the prison setting. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study was carried out in four correctional centres in New South Wales, Australia. This paper utilises Sekhon's Theoretical Framework of Acceptability to examine correctional, prison health, and study personnel's assessments of acceptability of HCV treatment as prevention in the prison setting. Correctional (n=24) and health personnel (n=17) including officers, nurses (including seven study nurses), and senior administrators across the four prisons where SToP-C was delivered, participated in interviews. This included two maximum security, one minimum security, and one women's medium/minimum security prison. Data analysis was informed by a seven-component theory of acceptability. Participants reported broad acceptability of HCV treatment as prevention in the prison setting across five components of acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy). Attributes contributing to acceptability included reduced HCV prevalence within the prison, and public health benefits for the community when people are released without HCV (affective attitude). Elements which may negatively impact on acceptability included limited clinic space (burden) and lack of correctional officers' understanding of availability of equivalent healthcare in the community (ethicality). System-wide prison participation was viewed as necessary for treatment as prevention to be successful (perceived effectiveness), while nonjudgmental care was seen as instrumental to HCV treatment scale up efforts (self-efficacy). Correctional and prison-based health personnel view HCV treatment as prevention as an acceptable health intervention. Overall, environmental issues relating to implementation (i.e., clinic space) were viewed as requiring a strategic approach to support prison-wide HCV treatment scale up.