Understanding the prison environment
Multiple factors arising from the physical prison structure, as well as the health and correctional workforce capacity, and the prisoner population, impose potential constraints on the logistics of scale-up of hepatitis C testing and treatment.
Issues
Access restrictions
Context
Recommendation
Segregation of prisoner groups may limit access.
Ensure planned access considers segregated prisoner populations.
Work or training programs may limit access.
Ensure planned access considers work or training constraints.
How is the daily schedule organised including ‘let-go’, meals, etc, and what are the ‘access windows’ – i.e. time periods for health service delivery.
Ensure planned access considers daily access windows.
How frequent are events that restrict access (‘lock-downs’, ‘visits’, ‘training days’)?
Ensure overall scale-up plans accounts for restricted access days.
The constraints within the core day can be a challenge, particularly if you’ve got a prison with limited time out of cell…”
Nurse
“Yeah, well, actually yesterday, there was a lock-down, so I thought “here we go, I’m not going to see anyone”
Nurse
Health clinic space
Context
Recommendation
What space and facilities within the prison are available to health services?
Ensure scale-up plans consider the capacity and competing demands for health clinic spaces.
“Having access to space in the clinic can be a real nightmare, cause there are lots of competing health care priorities…”
Nurse
Movements
Context
Recommendation
Are prisoners escorted individually by a correctional officer to/from the health clinic?
Ensure the impact of scale-up plans on both custodial and health service personnel are considered.
What is the turnover of prisoners in the centre?
Resolve what proportion of prisoners stay in the centre for a sufficient period to complete testing and treatment initiation.
