Lafferty L, Rance J, Byrne M, Milat A, Dore G J, Grebely J, Lloyd A R, Treloar C
Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia; The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia.
Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia.
Int J Drug Policy. 2022 Aug;106:103746. doi: 10.1016/j.drugpo.2022.103746. Epub 2022 May 27.
Hepatitis C (HCV) is highly prevalent among people who are incarcerated. HCV treatment-as-prevention was implemented in the SToP-C trial in four correctional centres in New South Wales , Australia to determine whether prison-wide scale up of antiviral treatment was an effective strategy to reduce HCV incidence and prevalence in the prison setting. A qualitative assessment was undertaken with prison-based correctional and health personnel at each of the four prisons to understand operational, sociological, and cultural barriers and enablers to scale up. Informed by a framework for scaling up population health interventions, this analysis examines recommendations by correctional and justice health personnel for HCV treatment-as-prevention scale up in the prison setting.
Correctional (n=24) and justice health (n=17) personnel, including officers, nurses, and senior administrators, participated in interviews across the four prisons where SToP-C was delivered and included two maximum security, one minimum security, and one women's medium/minimum security prisons.
Scaling up HCV treatment-as-prevention was contingent on compatibility (including sentence length), efficacy (securely funded positions for dedicated personnel and continuity of care for patients transferring between prisons), stakeholder analysis (generally the whole of prison workforce, particularly custodial officers and senior administrators), reach (reliant on peer and officer champions), and legitimised change (via dedicated officers who could instigate cultural shifts).
Achieving scale up of such an intervention should be guided by an understanding of the potential barriers and enablers. This analysis showed key considerations for HCV treatment-as-prevention scale up in correctional centres.
丙型肝炎（HCV）在被监禁人群中高度流行。在澳大利亚新南威尔士州的四个惩教中心开展的“停止丙型肝炎”（SToP-C）试验中实施了丙型肝炎治疗即预防措施，以确定在监狱范围内扩大抗病毒治疗是否是降低监狱环境中HCV发病率和流行率的有效策略。对四个监狱中基于监狱的惩教人员和卫生人员进行了定性评估，以了解扩大规模的操作、社会和文化障碍及促进因素。基于扩大人群健康干预措施的框架，本分析审视了惩教人员和司法卫生人员关于在监狱环境中扩大丙型肝炎治疗即预防措施的建议。
包括狱警、护士和高级管理人员在内的24名惩教人员和17名司法卫生人员参与了在开展SToP-C试验的四个监狱进行的访谈，这四个监狱包括两个高度设防监狱、一个低度设防监狱和一个女性中度/低度设防监狱。
扩大丙型肝炎治疗即预防措施取决于兼容性（包括刑期长度）、有效性（为专职人员提供有可靠资金支持的岗位以及为在不同监狱间转移的患者提供持续护理）、利益相关者分析（一般指整个监狱工作人员，尤其是狱警和高级管理人员）、覆盖面（依赖同伴和狱警倡导者）以及合法化变革（通过能够促成文化转变的专职狱警）。
实现此类干预措施的扩大规模应以了解潜在障碍和促进因素为指导。本分析显示了在惩教中心扩大丙型肝炎治疗即预防措施的关键考量因素。
