Understanding the legislative and policy framework
Timely access to both testing and treatment is a cornerstone of hepatitis care for prisoners.
The capacity for scale-up is determined in part by the relevant legislation and organisational policies, as well as the available funding for the hepatitis C tests and DAA treatments. In addition, the capacity of correctional and health services, as well as the philosophical approach of senior administrators towards provision of hepatitis services in the correctional setting, is key.
As prisoners lose autonomy in most aspects of daily decision-making, their participation in hepatitis C testing and treatment is largely determined by the system – which may actively support such care, passively allow some restricted access, or actively obstruct service provision.
Particularly if planning scale-up in a complex or multi-prison jurisdiction, it is critical to identify the existing policies that impact on hepatitis C care for prisoners, and the existing implementation of these policies (Lafferty et al, 2018).
If the legislative, policy, or funding environment does not support hepatitis services, advocacy to change this circumstance is essential before planning testing and treatment scale-up.
“You’ve got to look at organisational appetite and culture against a backdrop of the legal landscape. That’s the challenge: understanding what you’re operating with and understanding that seeing the world through a healthcare lens is only going to get you so far within a custodial environment.”
Policymaker
Issues
Policy constraints
Context
Recommendation
No hepatitis C policy for prisons.
Advocacy to support public health benefit of treatment of prisoners.
Financial limits on testing
Context
Recommendation
What budget constraints are there on scale-up of antibody and PCR testing.
Estimate scale-up potential within available budget;
Advocate for increased budget.
Financial limits on treatment
Context
Recommendation
What budget constraints are there on treatment.
Estimate scale-up potential within available budget;
Advocate for increased budget.
Local prison authorities unsupportive
Context
Recommendation
Individual leaders or groups unsupportive.
Highlight comparable centres with successful scale-up programs;
Targeted education and advocacy.
