Theme: Models of Care Year: 2024
Background: England has operated opt-out BBV testing at reception in all prisons since 2013. Paid HCV peers with previous lived experience have been working and testing in prisons since 2018.
In the context of limited staffing, stigma and misinformation, we describe a pilot in which residents (current prisoners) test others as they arrive into the prison system. The intervention aims to reduce fear and stigma around HCV, and to increase the offer and uptake of HCV testing within the prisons.
Model of care: The intervention was designed in HMP Birmingham, a men’s prison in central England, by residents, staff and The Hepatitis C Trust (HCT), a peer-led HCV NGO.
An established group of resident volunteers known as the Expectation Team (ET) – a group already supporting the reception process with strong relationships with other residents and prison leadership – was identified to take on the HCV role.
The group was trained initially to provide harm reduction, soon moving on to delivering HCV antibody tests. Nurses initially delivered results and RNA testing. Training was provided by HCT with prison healthcare.
Effectiveness: 3,906 people were tested by the ET between January 2023 and January 2024. From an average of 10% in 2022, average reception testing rose to 87% in 2023. C.80 prisoners have been diagnosed and treated.
One peer now delivers results with nurse and HCT support; patients report feeling comfortable with this and see the peers as part of the healthcare team. Strong buy-in and trust from prison leadership and healthcare was key to implementation.
Conclusion: This pilot demonstrates that – with the right relationships – prisoners can be trained and supported to offer important health interventions such as HCV testing and can achieve excellent results. To our knowledge, HMP Birmingham was the first prison in the UK – possibly wider – to trial this approach.
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