Theme: Models of Care Year: 2024
Background: HMP Berwyn is the largest UK prison, with a capacity of 2106. In October 2022, the Hepatitis C Trust (HCT) employed two paid peer staff and implemented a peer program in the prison. The key objective was to recruit and train prison peers to raise awareness and promote testing of hepatitis C (HCV) across 25 wings.
Description of model of care/intervention/program: Evaluation of the HMP Berwyn peer program collected quantitative data from April 2023 to September 2023 on:
•HCV education to staff and prisoners to decrease stigma and increase awareness
•HCV testing uptake
•Turn-around of declines for HCV testing
•Increased treatment uptake and adherence
Effectiveness: Thirteen peers worked with 440 inmates on a one to one basis. Peers facilitated 15 awareness sessions, with 102 attendees. 918 BBV leaflets were delivered. Testing uptake increased from 48% to 96%. 311 inmates who had previously declined tests agreed to test following peer-led education sessions. The decline to test rate has reduced from 18.7% to 3.6%, without using incentives. Qualitative data was also collected through two peer surveys. Peers reported improved relationships with staff and fellow prisoners, improved HCV knowledge, improved confidence and self-esteem. Inmates reported the importance of shared lived experience to encourage discussions of risky behaviours and get tested and treated.
Conclusion and next steps: Uptake of HCV testing has doubled since the introduction of peers. 96% of the prison population has been tested. Having diverse peers with lived experience helped reduce stigma, built rapport and provided education and support for HCV testing and treatment. This ensured all prisoners were offered tests, healthcare workloads reduced, and inmates had a sense of ownership over their own health in prison.
Next steps are to maintain elimination by testing inmates every 12 months and educating new inmates to ensure screening levels remain above 90%.