Author: Lafferty L, Rance J, Treloar C

Theme: Social Science & Policy Research Year: 2019

Background: Prisons are a high risk environment for the transmission of hepatitis C (HCV) due to the
high prevalence of HCV and no access to sterile injecting equipment for people who inject drugs
whilst incarcerated. Scale-up of hepatitis C (HCV) treatment among people with ongoing injecting
risk behaviours may lead to reductions in HCV prevalence and incidence (known as treatment as
prevention, TasP). Previous research showed that HCV was viewed as inevitable amid the prison
injecting culture, but with little understanding of how HCV treatment modified practices. This study
aimed to understand whether TasP influenced changes of risk behaviours in injecting culture
following prison-wide treatment scale-up.
Methods: Interviews were undertaken with n=24 patients across the four correctional centres
involved in the SToP-C study, including two maximum security prisons, one minimum, and one
women’s medium/minimum.
Results: Overall, several participants reported concern of future risk of HCV exposure due to having
no access to sterile injecting equipment and/or insufficient support for managing drug dependency.
Among participants reporting injecting drug use since commencing treatment (n=11; i.e., at risk of
reinfection), a majority indicated no change in their injecting practices. For others, smoking (rather
than injecting) was a viable means for maintaining HCV cure following treatment. Having personal
equipment afforded immediate protection against exposure, but was not viewed as a long-term
solution. Only one participant discussed a preference to use with others who had completed HCV
treatment and had achieved cure.
Conclusion: This research highlights ongoing risk practices following TasP in which access to harm
reduction strategies is limited. TasP programs in prison settings may be undermined by the absence
of increased access to harm reduction and subsequent inability for patients to protect against future
Disclosure of Interest Statement: The authors have no conflicts of interest.

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