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      Reducing barriers to the hepatitis C care cascade in prison via point‐of‐care RNA testing: a qualitative exploration of men in prison using an integrated framework

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          Abstract

          Background and Aims

          Hepatitis C virus (HCV) is highly prevalent within the prison setting. Although HCV testing and treatment are available within prisons, system barriers can impede progress along the HCV care cascade for those who are incarcerated. The PIVOT intervention used a ‘one‐stop‐shop‘ model (i.e. point‐of‐care HCV RNA testing, Fibroscan‐based liver disease assessment and treatment) at a reception prison in New South Wales, Australia. This analysis sought to understand the role of point‐of‐care HCV RNA testing at intake in reducing barriers to the HCV care cascade within the male prison setting.

          Design and Setting

          Qualitative analysis using semi‐structured interviews in a reception prison in Australia.

          Participants

          Twenty‐four men enrolled in the PIVOT study; all participants had undergone HCV point‐of‐care testing in the intervention arm.

          Measurements

          Høj's Integrated Framework informed this analysis.

          Findings

          Participants widely expressed the view that point‐of‐care HCV RNA testing on entry was beneficial for care engagement. Point‐of‐care testing was perceived as timely (compared with standard pathology) and reduced opportunities for adjudication by correctional officers due to fewer clinic visits for testing and results. Adoption of routine opt‐out testing at prison intake was regarded as an important strategy for normalising HCV testing (and likely to increase pathways to treatment uptake) and fostered patient candidacy (i.e. self‐perceived eligibility to access care).

          Conclusion

          Twenty‐four men in prison in New South Wales, Australia, who underwent opt‐out point‐of‐care HCV RNA testing on entry into prison, widely supported the programme as a means of overcoming barriers to HCV testing and treatment in the prison setting, as well as providing public health benefits through early detection of HCV infection among people entering into custody.

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          Most cited references47

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          Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study

          Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends.
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            Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees.

            The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population. Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-scale outbreaks. Our model indicates that decreasing the incarceration rate in people who inject drugs and providing opioid agonist therapy could reduce the burden of HIV in this population. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The most effective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.
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              Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013.

              Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013.
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                Author and article information

                Contributors
                l.lafferty@unsw.edu.au
                Journal
                Addiction
                Addiction
                10.1111/(ISSN)1360-0443
                ADD
                Addiction (Abingdon, England)
                John Wiley and Sons Inc. (Hoboken )
                0965-2140
                1360-0443
                12 February 2023
                June 2023
                : 118
                : 6 ( doiID: 10.1111/add.v118.6 )
                : 1153-1160
                Affiliations
                [ 1 ] Centre for Social Research in Health UNSW Sydney Sydney New South Wales Australia
                [ 2 ] The Kirby Institute UNSW Sydney Sydney New South Wales Australia
                [ 3 ] Justice Health and Forensic Mental Health Network NSW Health Matraville New South Wales Australia
                Author notes
                [*] [* ] Correspondence

                Lise Lafferty, Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney, NSW 2052, Australia.

                Email: l.lafferty@ 123456unsw.edu.au

                Author information
                https://orcid.org/0000-0002-8533-2957
                https://orcid.org/0000-0002-1833-2017
                https://orcid.org/0000-0002-8230-0386
                Article
                ADD16137
                10.1111/add.16137
                10952703
                36683132
                6e5d2052-bacf-45eb-ac68-b83ca2b2b42d
                © 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 June 2022
                : 04 January 2023
                Page count
                Figures: 0, Tables: 0, Pages: 8, Words: 7322
                Funding
                Funded by: National Health and Medical Research Council [NHMRC] , doi 10.13039/501100000925;
                Award ID: APP1135247
                Funded by: AbbVie , doi 10.13039/100006483;
                Funded by: Cepheid , doi 10.13039/100017037;
                Categories
                Research Report
                Research Reports
                Custom metadata
                2.0
                June 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:20.03.2024

                Clinical Psychology & Psychiatry
                care cascade,hepatitis c virus,integrated framework,point‐of‐care testing,prisons,qualitative research

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