Crowley D, Van Hout M C, Murphy C, Kelly E, Lambert J S, Cullen W
Irish College of General Practitioners, Lincoln Place, Dublin, Ireland.
Public Health Institute, Liverpool John Moore's University, Liverpool, UK.
Health Justice. 2018 Dec 19;6(1):23. doi: 10.1186/s40352-018-0081-6.
Prisons are a key location to access Hepatitis C Virus (HCV) infected people who inject drugs (PWID). Prison health care structures are complex and optimising health care delivery to this high need, marginalised and underserved population remains challenging. Despite international guidelines recommending that prisons are a priority location for HCV screening and treatment levels of prisoner engagement in HCV care remain low. Competing priorities between security and healthcare is a key feature of prison health care. A collaborative approach to health care delivery in prisons can maximise the benefits for prisoners, staff and the wider community.
To identify the barriers and enablers to HCV screening and treatment in Irish prisons and inform the implementation of a HCV screening program within the Irish Prison Services (IPS).
Qualitative study using focus group methodology underpinned by grounded theory.
The following themes emerged from the analysis: priority of safety and security, staffing and resources, concerns about personal risk, lack of knowledge, concerns around confidentiality, prisoners' fear of treatment and stigma, timing of screening, use of peer workers, in-reach hepatology and fibroscanning services. The primary role of prison security is to ensure the safety of staff and prisoners with a secondary but important supporting role in health care delivery. Maintaining adequate staffing levels and the provision of training and education were seen as priorities and impacted on prison officers' fear for personal safety and risk of HCV transmission. Opt-out screening and peer support workers had high levels of support among participants.
Upscaling HCV management in prisons requires an in-depth understanding of all barriers and facilitators to HCV screening and treatment. Engaging prison officers in the planning and delivery of health care initiatives is a key strategy to optimising the public health opportunity that prisons provides.
监狱是接触丙型肝炎病毒（HCV）感染的注射吸毒者（PWID）的关键场所。监狱医疗保健结构复杂，向这一有高需求、边缘化且服务不足的人群提供优化的医疗保健服务仍然具有挑战性。尽管国际准则建议监狱是丙型肝炎病毒筛查和治疗的优先场所，但囚犯参与丙型肝炎病毒护理的水平仍然很低。安全与医疗保健之间相互竞争的优先事项是监狱医疗保健的一个关键特征。采用协作方式提供监狱医疗保健服务可以使囚犯、工作人员和更广泛的社区获得最大利益。
确定爱尔兰监狱中丙型肝炎病毒筛查和治疗的障碍与促进因素，并为爱尔兰监狱管理局（IPS）实施丙型肝炎病毒筛查计划提供信息。
采用基于扎根理论的焦点小组方法进行定性研究。
分析得出以下主题：安全与安保的优先级、人员配备与资源、对个人风险的担忧、知识匮乏、对保密性的担忧、囚犯对治疗和耻辱感的恐惧、筛查时间、同伴工作人员的使用、内部肝病学和纤维扫描服务。监狱安全的主要作用是确保工作人员和囚犯的安全，在提供医疗保健方面起次要但重要的支持作用。维持足够的人员配备水平以及提供培训和教育被视为优先事项，并影响到狱警对个人安全和丙型肝炎病毒传播风险的担忧。非强制筛查和同伴支持人员在参与者中获得了高度支持。
扩大监狱中丙型肝炎病毒的管理需要深入了解丙型肝炎病毒筛查和治疗的所有障碍与促进因素。让狱警参与医疗保健举措的规划和实施是优化监狱提供的公共卫生机会的关键策略。
