Panahi Idin, Selvey Linda A, Puljević Cheneal, Kvassay Amanda, Grimstrup Dorrit, Smirnov Andrew
School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
Queensland Injectors Health Network, Bowen Hills, QLD 4006, Australia.
Int J Environ Res Public Health. 2025 Feb 7;22(2):238. doi: 10.3390/ijerph22020238.
Highly effective direct-acting antiviral (DAA) therapies for hepatitis C (HCV) have been available in Australian prisons since 2016. To address treatment interruption following release from prisons, the Queensland Injector's Health Network (QuIHN) launched a Prison Transition Service (PTS) in south-east Queensland, Australia. Presently, the factors associated with continuity of post-release HCV care are poorly understood. The objective of this qualitative study was to explore the barriers and facilitators to HCV treatment among people recently released from prisons among PTS clients and stakeholders. Qualitative interviews were conducted with 27 participants, namely, 13 clients and 14 stakeholders (health and community support workers) of the PTS. We conducted thematic analysis using the framework of person-, provider-, and system-level barriers and facilitators. Person-level barriers included competing priorities post-release, while facilitators included self-improvement after treatment completion, preventing transmission to family, and social support. Provider-level treatment barriers included enacted stigma, limited prison health service capacity, and post-release health system challenges. Systemic barriers included stigma relating to HCV, injecting drug use, incarceration, and limited availability of harm reduction services. Policy changes and investment are required to expand HCV treatment in south-east Queensland prisons to facilitate patient navigation into community care. In terms of reducing stigma among health staff and the general community towards people with HCV, a history of incarceration and/or who inject drugs is crucial for improving treatment rates. Strategies such as peer-led or nurse-practitioner-led models of care may help improve treatment completion. Continuity of HCV treatment post-release from prisons is essential for Australia to meet the WHO's 2030 HCV elimination target.
自2016年以来,澳大利亚监狱就已提供治疗丙型肝炎(HCV)的高效直接抗病毒(DAA)疗法。为解决囚犯出狱后治疗中断的问题,昆士兰注射器使用者健康网络(QuIHN)在澳大利亚昆士兰州东南部启动了一项监狱过渡服务(PTS)。目前,人们对与出狱后丙型肝炎护理连续性相关的因素了解甚少。这项定性研究的目的是探讨PTS服务对象和利益相关者中刚出狱人员接受丙型肝炎治疗的障碍和促进因素。对27名参与者进行了定性访谈,其中包括13名PTS服务对象和14名利益相关者(卫生和社区支持工作者)。我们使用个人、提供者和系统层面的障碍及促进因素框架进行了主题分析。个人层面的障碍包括出狱后事务繁多,而促进因素包括治疗完成后的自我提升、防止传染给家人以及社会支持。提供者层面的治疗障碍包括明显的污名化、监狱卫生服务能力有限以及出狱后卫生系统面临的挑战。系统性障碍包括与丙型肝炎、注射吸毒、监禁相关的污名化以及减少伤害服务的可及性有限。需要进行政策变革和投资,以扩大昆士兰州东南部监狱的丙型肝炎治疗,促进患者转向社区护理。在减少卫生工作人员和普通社区对丙型肝炎患者、有监禁史者和/或注射吸毒者的污名化方面,对于提高治疗率至关重要。同伴主导或执业护士主导的护理模式等策略可能有助于提高治疗完成率。囚犯出狱后丙型肝炎治疗的连续性对于澳大利亚实现世界卫生组织2030年消除丙型肝炎的目标至关重要。