Purpose
Hepatitis C (HCV)
infections are prevalent in custodial settings worldwide, yet provision of
antiviral therapies is uncommon. Approximately 30,000 prisoners are held in
Australian prisons at any one time, with more than 30 per cent testing positive
for HCV antibodies. Prisoners have been identified in the National Hepatitis C
Strategy as a priority population for assessment and treatment. The purpose of
this paper is to examine the rates of HCV testing and treatment, as well as
barriers and opportunities for development of infrastructure for enhanced
services.
Design/methodology/approach
Interviews were conducted with 55
stakeholders from the correctional sector in each state and territory in
Australia in two stages: service directors to gather quantitative data
regarding rates of testing and treatment; and other stakeholders for
qualitative information regarding barriers and opportunities.
Findings
Of
more than 50,000 individuals put in in custody in Australian prisons in 2013,
approximately 8,000 individuals were HCV antibody positive, yet only 313
prisoners received antiviral treatment. The barriers identified to assessment
and treatment at the prisoner-level included: fear of side effects and the
stigma of being identified to custodial authorities as HCV infected and a
likely injecting drug user. Prisoners who came forward may be considered
unsuitable for treatment because of prevalent mental health problems and
ongoing injecting drug use. Provision of specialist hepatitis nurses and
consultants were the most frequently recommended approaches to how prison
hepatitis services could be improved.
Originality/value
Many personal and
systems-level barriers relevant to the delivery of HCV treatment services in
the custodial setting were identified. Ready access to skilled nursing and
medical staff as well as direct acting antiviral therapies will allow the
prison-sector to make a major contribution to control of the growing burden of
HCV disease.
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By:
- 1Inflammation and Infection Research Centre (IIRC), School of Medical Sciences, University of New South Wales, Australia.
- Int J Prison Health. 2016 Mar 14;12(1):3-16. doi: 10.1108/IJPH-08-2015-0025.
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