Understanding availability and barriers to scaling-up prison-based hepatitis C services and perceived advocacy needs globally to inform a prison-based advocacy toolkit: The INHSU Prisons Advocacy Toolkit Project.

Author: Lok Bahadur Shrestha, Yumi Sheehan, Olivia Dawson, Shelley Walker, Andrew Lloyd, Matthew J Akiyama, Nadine Kronfli

Theme: Epidemiology & Public Health Research Year: 2023

Background: Few advocacy resources exist to improve hepatitis C (HCV) care in carceral settings. As part of the INHSU Prisons Advocacy Toolkit project, a mapping study was undertaken to: i) evaluate the availability of HCV-related healthcare services in carceral settings across various national socio-economic strata; ii) assess the barriers to scaling up these services; and iii) understand the perceived advocacy needs and tools that would best support advocacy efforts in the sector.

Methods: A short online survey consisting of closed and opened-ended questions was disseminated to global networks of people engaged in HCV care (n=3763 across INHSU, INHSU Prisons, and partner mailing lists) with two rounds of invitation. The data was extracted into Microsoft Excel and subjected to statistical analysis utilizing R Studio.

Results: Respondents (n=181) were predominantly female (55%), involved in implementation of prison HCV services (48%), and from high income (62%) countries. HCV services differed significantly across socio-economic status vis-à-vis the reported availability of: HCV antibody testing, HCV RNA testing, fibrosis assessment, and direct-acting antivirals (DAAs) (all p <0.001). Inadequate prison HCV healthcare resources were perceived as the key barrier to scaling-up prison-based HCV services across all country contexts, underpinned by the high cost of DAAs, and limited motivation by policy makers and funders (all p <0.001). Advocacy tools considered to be most useful were best practice case studies and infographics; social media templates were endorsed by respondents from low and lower-middle income countries.

Conclusion: The availability of HCV testing and treatment services in prisons varies considerably across socio-economic categories. To advance HCV services in carceral settings, advocacy tools that address the principal barriers and that are tailored to various country contexts are needed.

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