‘Fighting a losing battle’: prisoners’ perspectives of treatment as prevention for hepatitis C with inadequate primary prevention measures

Abstract

Hepatitis C virus (HCV) is a global public health concern. Prisoners are particularly affected, with high prevalence and ongoing HCV transmission. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study is implementing the first trial of HCV treatment as prevention (TasP) in the prison setting, i.e., scaling up treatment at sufficient scale to achieve a preventive effect. This qualitative sub-study sought to explore prisoners’ perceptions of feasibility of TasP. Participants were recruited from four correctional centres in New South Wales, Australia, including one women’s prison. Thirty-two prisoners with a history of injecting drug use participated in interviews prior to prison-wide HCV treatment scale-up. All participants had been screened for HCV within the previous 6 months; half (n = 16) had chronic HCV; n = 2 were awaiting test results. Concerns regarding prisoner movements (e.g. transferred to another prison, or incarceration-release-incarceration) and perceived subsequent risks for HCV reinfection were consistently raised as a major challenge for TasP elimination efforts. Suggestions for harm reduction measures to assist TasP effectiveness (and reduce risk of re-infection) included education and prison needle syringe programmes. Prisoners remain concerned about long-term effectiveness of TasP efforts without access to effective prevention measures and subsequent risk of (re-)infection.

Keywords:

• Harm reduction strategies
• hepatitis C
• prison
• reinfection
• treatment as prevention

Acknowledgements

The authors gratefully acknowledge the pivotal role played by the following partner organisations and key stakeholders in study planning and implementation: Justice Health & Forensic Mental Network; Corrective Services NSW; NSW Health; Hepatitis NSW; NSW Users and AIDS Association; the Community Restorative Centre; and the Aboriginal Health & Medical Research Council. We would like to recognise the contribution of current and past researchers and staff involved in the study at the participating correctional centres. Finally, the authors would like to thank the study participants for their generous contribution to the research.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This research was supported in part by Gilead Sciences, Inc. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Gilead Sciences, Inc. The research was also supported by the Department of Health and Ageing, Australian Government through a National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1092547). The contents of the published material are solely the responsibility of the individual authors and not do not reflect the views of NHMRC. The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The Centre for Social Research in Health is supported by a grant from the Australian Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government.