Bridging the prison to community gap in HCV treatment

Author: Lee Cristensen, Sorcha Daly, Leila Reid, Sean Cox, Rachel Halford, Sean Cox, Leila Reid

Theme: Models of Care Year: 2023

Prisoners diagnosed with HCV in prison who are then released or transferred often don’t get the treatment they need. Problems with medication transfer, referrals to community healthcare, and homelessness on release are common. This often means patients disengage or can’t complete treatment. 

The Hepatitis C Trust (HCT), a UK peer-led NGO, runs national community and prison peer services. In 2019 HCT established the Follow Me through the gate model to ensure prisoners aren’t lost to follow up.

Description of model of care/intervention:
Information sharing protocols were established between HCT, community healthcare, prison healthcare and prisons. Prisoners are referred by nurses. Peers then work with the patient before release, where possible, alongside healthcare. Peers build trust with patients, utilising this to maximise ongoing engagement. 
Peers and referring nurses glean as much information as possible from patients in case they’re released early – where they might sleep, where they might beg, where they might get opiate substitution. As phones are often temporary, numbers for parents, partners and friends are taken: anything that could help find that person in the community. 
In these cases the team use an assertive outreach model to find patients, visiting identified settings and services until they find the patient. 

In 2022-3, the programme received 553 referrals.  To date, 317 have started treatment, 32 have a documented SVR.  All were successfully linked to community. While prisoners are keen to engage, finding people following release – especially when released with little or no notice – can take many hours or days. 

Conclusion and next steps:
This programme hinges on strong, trusting relationships between peers and prisoners, as well as between NGOs, prison staff and health services. As prison release can be a particularly high-risk time for overdose and BBV infection, effective support around HCV can have important wider impacts.

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