Lafferty Lise, Rance Jake, Grebely Jason, Dore Gregory J, Lloyd Andrew R, Treloar Carla
Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia.
Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia.
Int J Drug Policy. 2020 Mar;77:102693. doi: 10.1016/j.drugpo.2020.102693. Epub 2020 Feb 8.
Hepatitis C (HCV) infection is highly prevalent within the prison setting. Direct-acting antiviral (DAA) therapies have changed the HCV treatment landscape, offering simple treatment (with minimal side-effects) and high efficacy. These advances have enabled the first real-world study of HCV treatment as prevention (TasP), the Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study. This paper draws on data from qualitative interviews completed with SToP-C participants following prison-wide DAA treatment scale-up.
Semi-structured interviews were undertaken with 23 men in prison following HCV treatment completion to identify ongoing risk practices, perceptions of strategies for HCV prevention within the prison setting, experiences of HCV treatment (as prevention), and perceptions of reinfection following cure. Analysis was undertaken using a counterpublic health lens to identify risks and perceptions of reinfection among people treated for HCV within the prison setting.
Participants identified a number of challenges of meaningful HCV 'cure' in the absence of increased access to prevention strategies (e.g., opioid agonist therapy and prison needle syringe programs) along with concerns that 'cure' was only temporary whilst incarcerated. 'Cure' status included self-perceptions of being "clean", while also imposing responsibility on the individual to maintain their 'cure' status.
HCV DAA treatment is provided somewhat under the guise of 'cure is easy', but fails to address the ongoing risk factors experienced by people who inject drugs in prisons, as well as other people in prison who may be at risk of blood-to-blood exposure. Health messaging regarding HCV treatment and treatment for reinfection should be tailored to ensure patient-centred care. Health interventions in prison must address the whole person and the circumstances in which they live, not just the illness.
丙型肝炎（HCV）感染在监狱环境中极为普遍。直接抗病毒药物（DAA）疗法改变了HCV的治疗格局，提供了简单的治疗方法（副作用极小）且疗效显著。这些进展促成了对HCV治疗即预防（TasP）的首次实际研究，即丙型肝炎囚犯监测与治疗（SToP-C）研究。本文借鉴了在全监狱范围内扩大DAA治疗后，对SToP-C参与者进行的定性访谈数据。
对23名完成HCV治疗的在押男性进行了半结构化访谈，以确定持续存在的风险行为、对监狱环境中HCV预防策略的看法、HCV治疗（作为预防）的经历以及治愈后对再感染的看法。采用反公共卫生视角进行分析，以确定监狱环境中接受HCV治疗者的再感染风险和看法。
参与者指出，在缺乏更多预防策略（如阿片类激动剂疗法和监狱针头注射器项目）的情况下，实现有意义的HCV“治愈”存在诸多挑战，同时担心在监禁期间“治愈”只是暂时的。“治愈”状态包括自我感觉“干净”，同时也要求个人承担维持其“治愈”状态的责任。
HCV DAA治疗在某种程度上是以“治愈很容易”为幌子进行的，但未能解决监狱中注射毒品者以及其他可能面临血液接触风险的在押人员所面临的持续风险因素。关于HCV治疗和再感染治疗的健康信息应进行调整，以确保以患者为中心的护理。监狱中的健康干预措施必须关注整个人及其生活环境，而不仅仅是疾病。
