Theme: Models of Care Year: 2024
Background: People engaged with criminal justice systems often face barriers to hepatitis C (HCV) services including low awareness, stigma, poor access and distrust in healthcare. England’s prison programme seeks to overcome this by embedding staff with lived experience (peers) in prison health teams. We describe findings of an evaluation of the programme since national implementation in 2019.
Model of care: Peers work in all 112 adult prisons. They have full security clearance and hold keys, enabling them to work independently, consistently and with confidentiality. Peers provide support, educate prisoners and staff, train volunteers, and collaboratively work to strengthen HCV pathways.
HCT also lead ‘HITTs’, mass-testing programmes which aim to test all residents in a prison over 3-5 days and drive-up reception testing.
Where people leave prison on treatment, HCT’s through the gate service links people with community support.
Effectiveness: In five years, peers have become a pivotal part of HCV care in prison and had wide-ranging impacts.
Almost 6,000 prison staff and 12,000 residents have attended HCV education/engagement sessions.
52,543 people have been tested through 80 HITTs; average uptake 87%. These have identified 3,835 people (7.3%) with HCV antibodies – including 49% of residents in one prison – and 632 with HCV RNA. 408 (65%) have started treatment.
National reception testing increased from 10.5% in 2016/17 to 78% in January 2024.
Resident feedback highlights the value of lived experience for trust and changing attitudes. Collaboration with national prison and healthcare leadership has been critical.
The programme is continuously developing. Recent innovations include resident-delivered testing; integrated BBV/STI screening; and a mass stigma reduction programme.
Conclusions & next steps: Peers can be effective in increasing HCV testing and treatment in prisons, changing stigma and culture. This model has applicability for other health conditions impacting criminal justice populations.
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