Process evaluation
The potential questions to be asked and answered in the process evaluation include measures related to each milestone in the hepatitis C care cascade.
Examples of such questions are provided below.
Milestones
Education
Question
Desired Outcome
How many education sessions or educational resource exposures happened for health care providers?
How many education sessions or educational resource exposures happened for correctional officers?
How many education sessions or educational resource exposures happened for prisoners?
Significant improvements in knowledge, attitudes, and behaviours of health care providers, correctional officers and prisoners towards hepatitis C testing and treatment should be measured using validated tools.
Screening
Question
Desired Outcome
How many prisoners had risk behaviour screened?
How many prisoners had hepatitis C antibody testing?
How many prisoners had hepatitis C PCR testing for viraemia?
Good coverage – the proportion of all prisoners, and those at risk, who were tested and were diagnosed with chronic hepatitis C?
Prescription and provision of DAAs
Question
Desired Outcome
How many prisoners commenced DAA treatment?
Good prescribing and dispensing systems – the proportion of all those prepared for treatment who actually commence DAA treatment
Monitoring for cure
Question
Desired Outcome
How many prisoners who initiated treatment were cured?
Good treatment adherence and follow-up – the proportion of those treated who are cured.
Monitoring for reinfection
Question
Desired Outcome
How many prisoners who were cured become reinfected when monitored regularly?
Good surveillance for reinfection – the proportion of those who were cured who become reinfected. The proportion who were provided access to harm reduction measures.
Retreatment
Question
Desired Outcome
How many prisoners were retreated?
Timely and broad retreatment for prisoners who have relapsed post-treatment or who become reinfected - time to retreatment, and proportion of those those relapsing and reinfected who go onto retreatment.
In addition to these positive process measures, it is also important to consider: the challenges faced in engaging prisoners in testing and treatment, and solutions which made the implementation process more efficient and acceptable; the resources required to achieve scale-up, and declines in other health care activities resulting from the hepatitis testing and treatment scale-up.
