30 March 2021
INHSU Prisons – a dedicated special interest group within INHSU – recently held a ‘speed geeking’ event, welcoming experts from across North America to share their knowledge and expertise about diagnosing and treating hepatitis C in the prison environment.
Liesl Hagan is an epidemiologist with the Centers for Disease Control and Prevention, Division of Viral Hepatitis, where she develops guidance for the prevention and control of hepatitis A, B, and C in correctional settings and provides technical assistance to jurisdictions on hepatitis-related data analysis projects including cost-effectiveness studies and programmatic evaluations. She also co-chairs the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Workgroup on Correctional Health. Liesl has also led CDC’s COVID-19 Corrections Unit during the ongoing pandemic, where she has developed guidance and worked with state and local health departments, federal agencies, correctional and detention facilities, and other stakeholders on surveillance, data analysis, and outbreak investigations.
Hepatitis C cases are increasing in the US, largely because of injection drug use during the opioid crisis. Because such a large percentage of people who inject drugs are incarcerated, corrections are in a unique position at the intersection of drug use and hepatitis C transmission. Data on prevalence in corrections to monitor our progress are sparse, and we fill gaps in national surveillance data in many different ways – all with their strengths and drawbacks. Challenges to addressing hepatitis C data collection in corrections include different testing strategies and difficulty advocating for funding to treat people who are infected. Public health and corrections can support each other through deeper relationships and more communication.
- Across countries, comprehensive HCV surveillance in corrections runs into challenges related to the lack of integrated data systems from local, state/provincial, and national jurisdictions. This ranged from paper reporting in some countries, to the use of different EMR systems in others
- There was interest in success stories/model programs for how to fund HCV treatment in corrections. (Examples from the US are the VA health system, Cherokee Nation, and subscription pricing systems developed in Louisiana and Washington state
- Australia has had success getting comprehensive data on HCV prevalence, and even incidence, in corrections – so they are moving on to capturing treatment uptake data
Daniel Rowan, Extension for Community Healthcare Outcomes (ECHO)
Daniel Rowan is Program Manager for Project ECHO’s Peer Education Programs in Albuquerque, New Mexico.
The major theme that emerged was an interest in the specific logistical challenges of working with and in a correctional setting. There was agreement that starting a new program is difficult without close allies in government who can help pave the way for new programs. The importance of utilising peers was a theme that emerged several times as well.
- Logistical challenges of starting a new prison peer educator group
- Developing relationships with prisons and government to start prison peer education
- What is expected of peer educators
- How to select peer educators
- How peer educators can work with medical within the institution
Sofia Bartlett, University of British Columbia
Sofia Bartlett is a Postdoctoral Research Fellow at the University of British Columbia, based at the BC Centre for Disease Control in Vancouver, Canada. Her research is related to understanding the overlap of Sexually Transmitted and Blood-Borne Infections, substance use, and incarceration. COVID-19 has created challenges to doing research involving people who are incarcerated, but it has also created unique opportunities, such as the ability to have video meetings with groups of people in prison to get their input on research design and methodology. Sofia will discuss how she was able to do things like this during 2020, and the benefits it has bought to research studies she is involved with.
Sofia focused on the benefits of integrating People With Lived Experience (PWLE) into the design and implementation of research studies involving people who are incarcerated or recently incarcerated. Her session included advice such as:
- Ensure that research aims and findings address the concerns and needs of people who experience incarceration
- Make participation in research safe and non-traumatising– this may also assist in expediting Research Ethics Board approvals
- Improve the validity and accuracy of data collected by having survey instruments and consent forms reviewed prior to deployment
Sofia advised various ways to do this including:
- Forming a Governance Committee to oversee research studies and include PWLE on this committee
- Hold focus groups with people in prison to review study documents (this can often be facilitated through Programs Officers & done over Zoom etc.)
- Recruit people recently released from prison through CBOs to participate in focus groups
- Honorarium payments for committee meetings and involvement in focus groups must be offered at ‘peer payment standard’ (e.g. in British Columbia this is $25 CAD per hour minimum)
Other observations from Sofia’s session included:
- Community-based organisations have been doing this for years. It’s time for academia to catch up
- Almost everyone agreed that it seems like a no-brainer and we should be doing more consultation with PWLE of incarceration into research design and implementation
- Some of the barriers to doing this that were discussed include; funding; need to pay people who are consulting on research, need to pay people organising the consulting, etc. and this isn’t usually included in research grant funding budgets representation; need to try and ensure that the people we consult with are representative of the broader prison population
Yumi Sheehan, Kirby Institute UNSW
Yumi is a Project Coordinator at the Kirby Institute UNSW Sydney, managing several HCV and prison-related research studies and initiatives – including INHSU Prisons. Yumi is also undertaking a PhD, focusing on strategies to enhance access to HCV testing and treatment for prisoners.
Yumi discussed a project that consists of establishing a point of care ‘one-stop-shop’ HCV clinic to streamline and enhance throughput in the HCV care cascade for new receptions to prison. The ‘one-stop-shop’ includes on-site point of care HCV RNA testing (Xpert HCV VL fingerstick) coupled with a fibroscan, clinical assessment, and early prescription of DAA therapy – all in the one 60-minute visit – followed by fast-tracked treatment initiation.
- There were lots of interest in this model of care, and participants shared that similar streamlined models are being implemented in settings across the globe
- They discussed important factors to consider for implementing a similar model in your setting, such as:
- Any restrictions on access to DAA therapies for prisoners
- Availability of PoC testing (licensed vs research use only)
- Available workforce capacity: dedicated correctional officers are recommended, with HCV care decentralised to nursing staff
- Cost-effectiveness compared with the standard of care model
Mandy Altman, National Hepatitis Corrections Network
During her session, Mandy discussed the history and resources of the National Hepatitis Corrections Network. Attendees learned about ways the network can assist their work and discussed ways to promote better dissemination of best practices within the viral hepatitis in the corrections landscape:
- The changing landscape of viral hepatitis knowledge and resources during the COVID-19 pandemic
- Universal education resources that can be shared between countries
- The importance of having a space for community members and advocates to promote better viral hepatitis testing and treatment policies in correctional settings
Alison O Jordan, ACOJA Consulting
ACOJA Consulting is an internationally recognised team skilled in strategic planning and guidance for health and human services, university research, and government programs. M/WBE certified.
Alison’s session discussed:
- Discontinuity of treatment for folks leaving prisons was a concern
- Funding for public health interventions in correctional settings
- SU as a barrier to continuity of treatment
- Linkage to care rates for HCV below what we see for HIV needs more evaluation
- Benefits of peers and people with lived experience as facilitators
- Universal health care and funding for treatment during incarceration is also a facilitator
Become a member of INHSU Prisons
If you’re interested in hepatitis C and the health of people who use drugs in prison, we encourage you to become a member of INHSU Prisons and connecting with a global network of people within the sector. Membership is possible via the main INHSU membership which costs just €90 for full membership and €30 for nurses/allied health or low-middle income countries. Find out more here.