Understanding the existing hepatitis C testing and treatment services
It is important to develop the plan with a good understanding of the existing hepatitis C testing and treatment services in the prison, and their strengths and weaknesses.
Issues
Organisational structure
Context
Recommendation
What organisation is responsible for hepatitis C testing and treatment of prisoners (correction or health authority or independent agency?
Ensure engagement and support of all relevant providers in the plan.
Hepatitis C education
Context
Recommendation
What hepatitis C education and training is provided to healthcare providers, correctional staff, prisoners?
What is the level of knowledge regarding hepatitis C and its treatment amongst healthcare providers, correctional staff, prisoners?
What are the attitudes of healthcare providers, correctional staff, prisoners towards hepatitis C testing and treatment of prisoners?
Ascertain the knowledge, attitudes and behaviours of healthcare providers, correctional staff, and prisoners regarding hepatitis C testing and treatment of prisoners; consider gathering such information if not available to inform the education component of the implementation plan.
“I’m pretty sure I have hep C, but I’m not sure about the treatment – I’ve got lots of stuff going on at the moment…”
Prisoner
Health service model
Context
Recommendation
What is the model of care for hepatitis C, including all of the elements (education, screening, clinical and laboratory assessments, prescription and provision of DAA medication; monitoring post-treatment; monitoring after cure for reinfection, retreatment)?
Who provides each element of the model?
How efficient is the model?
Ensure a good understanding of the existing model of care, all of all relevant providers, and the service capacity and efficiency notably for risk behaviour assessments, venepuncture, fibrosis assessment, approach (fibro-elastography or laboratory algorithm) and clinical assessments; identify points in the care cascade which are rate-limiting (e.g. specialist assessments or prescriptions).
“I’ve been in and out of prison for years and originally I spent a year or so waiting to be seen by the doctor. Nowadays, the nurses really do most stuff – I think it’s great, because they get to know yer pretty well…”
Prisoner
Medication
Context
Recommendation
How is DAA medication managed?
How is medication managed in terms of purchase, distribution, storage, and dispensing?
How is medication provided to prisoners self-administered (with weekly or monthly supplies) or daily supervised administration?
“I’ve been in and out of prison for years and originally I spent a year or so waiting to be seen by the doctor. Nowadays, the nurse really do most stuff – I think it’s great, because they get to know yer pretty well…”
Prisoner
