The Role of Point-Of-Care Hepatitis C RNA Testing at Prison Intake For Reducing Barriers to The Hepatitis C Care Cascade

Author: Lise Lafferty Yumi Sheehan Amanda Cochrane Jason Grebely Andrew Lloyd Carla Treloar

Theme: Social Science & Policy Research Year: 2022

Hepatitis C (HCV) is highly prevalent among people in prison. However, numerous systems barriers
can prevent progression through the HCV care cascade for those who are incarcerated. This study
evaluated a ‘one-stop-shop’ model (i.e., point-of-care HCV RNA testing, Fibroscan®-based liver
disease assessment, and HCV treatment) to enhance HCV treatment uptake at a reception prison in
New South Wales, Australia. Utilising Hoj’s Integrated Framework, this analysis seeks to understand
the role of HCV RNA point-of-care testing in reducing barriers to the HCV care cascade in prison.
Twenty-four men in prison enrolled in the intervention arm of the PIVOT study (received point-ofcare testing) participated in semi-structured interviews. Participants were purposively selected to
ensure comparable representation of 1) prior (standard pathology) or no prior HCV testing history;
and 2) history or no history of injecting drug use.
Participants widely believed that point-of-care HCV RNA testing upon entry was beneficial for care
engagement. Point-of-care testing was perceived as timely (compared with standard diagnostic
pathology testing at an external laboratory) and reduced opportunities for adjudication (such as
judgment from service providers), while adoption of routine opt-out testing at prison intake was
regarded as an important strategy for normalising testing (and likely to increase pathways to
treatment uptake), and fostered patient candidacy (that is, self-perceived eligibility to access care).
Opt-out point-of-care HCV RNA testing was widely supported by participants as a means for
overcoming barriers to HCV testing and treatment in the prison setting, as well as providing public
health benefits through early detection of HCV infection among people entering into custody.
Disclosure of Interest Statement:
LL and AC have received speaker fees from AbbVie. JG is a consultant/advisor and has received
research grants from Abbvie, Cepheid, Gilead Sciences, Hologic, Indivior, and Merck/MSD. ARL has
received investigator-initiated research support from Gilead and Abbvie. CT has received speaker
fees from AbbVie and Gilead Sciences and has received research funding from Merck for unrelated
research. YS has nothing to declare.

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