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- Understanding the legislative and policy framework
- Understanding the prison environment
- The prisoner population
- Understanding the existing hepatitis C testing and treatment services
- Engaging stakeholders and formulating the plan
- Correctional authority – planning
- Health services – planning
The prisoner population
Key data to inform the scale-up plan should include the prisoner population size and demographic characteristics, sentence duration, and turnover (numbers of new prison entrants, transfers, and those released to freedom).
In addition, surveillance estimates of the proportion of prisoners with chronic hepatitis C infection, including major sub-populations (men/women, ethnic minorities) should be sought to inform approaches targeted to these groups.
Existing custodial and health data collection systems and ways in which to access data should be identified during the planning phase to facilitate ongoing monitoring and evaluation of scale-up.
Prisoner custodial data
How many prisoners are in the centre?
What are their security classifications?
What is the distribution of length of stay in the centre?
Ensure existing custodial data collection systems can provide recent historical data to inform planning.
“The problem you have with the female offenders is that they don’t get the long sentences like the men, so they may be here and they might start something, but then they get released”.
Prisoner health data
What proportion of the prisoner population have chronic hepatitis C (i.e. hepatitis C antibody and PCR positive)?
What proportion of the prisoner population are at risk of new hepatitis C infection (either primary infection or reinfection)?
What is the prevalence of risk behaviour (injecting drug use, sharing, unsafe tattooing) in the prison?
Identify existing epidemiological datasets to provide estimates, including from comparable centres; extract data from health datasets; or conduct a prevalence survey.