Featured Article
Article Title
People in community corrections are a population with unmet need for viral hepatitis care
Authors
Rebecca J. Winter - Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Samara Griffin - Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Yumi Sheehan - Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
Winnie Nguyen - Hepatitis Queensland, Brisbane, QLD, Australia
Mark Stoové - Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
Andrew R. Lloyd - Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
Alexander J. Thompson - Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
On behalf of the National Prisons Hepatitis Network
Abstract
To reach World Health Organization elimination targets for hepatitis C, different strategies are needed to reach people who have not yet been diagnosed and treated. In the context of declining treatment initiation rates, innovation in service design and delivery is necessary: testing and treatment needs to be offered to people in non-traditional settings. The community corrections (probation and parole) population is larger than the prison population, which has high prevalence of hepatitis C and—in some countries—established diagnosis and treatment programs. In this Viewpoint we identify a gap in hepatitis C care for people under community correctional supervision, a group who have either never been imprisoned or need continuity of healthcare provided in prison. We propose that offering hepatitis C screening and treatment would benefit this population, and accelerate progress to hepatitis C elimination.
Keywords
Hepatitis C virus; Models of care; Community corrections; Probation; Parole; Justice health; Elimination strategies
Summary of Research
“People with criminal justice system involvement typically suffer poor health and reduced access to primary healthcare due to poverty and social exclusion. Worldwide, carceral populations have high prevalence of infectious diseases including HIV, tuberculosis, viral hepatitis, and sexually transmitted infections and are identified as a special population for public health focus by the World Health Organization (WHO). Despite carceral populations being at high risk for viral hepatitis infection and improved evidence of the efficacy of prison-based viral hepatitis care, community-based viral hepatitis care services typically struggle to engage people with criminal justice system involvement…
Community corrections supervise people serving a court-ordered sentence in the community. Community-based supervision of offenders can be ordered as an alternative to prison (probation), or as a condition of release from prison (parole)... people involved in the community corrections (probation and parole) system are a key underserved population who could benefit greatly from accessible and streamlined hepatitis C testing and treatment services… offering hepatitis C services in community corrections settings could accelerate progress towards reaching WHO hepatitis C elimination targets…
There are an estimated 1.5 million new hepatitis C infections each year, 290,000 hepatitis C related deaths, and less than a quarter of the estimated 57 million people infected worldwide are diagnosed… Among an estimated 10.7 million people incarcerated in prisons worldwide, approximately 1.5 million (15%) are estimated to be living with hepatitis C infection” (p. 1).
“…For typically marginalised and stigmatised populations such as people who inject drugs and people who interact with the criminal justice system, the current hepatitis C cascade of care in mainstream health services is onerous. Attrition from the care cascade has already been extensively described in community studies of people who inject drugs and in prisons” (p. 2-3).
“System and capacity constraints also mean that people diagnosed with or at risk of hepatitis C sometimes miss out on opportunities to access treatment in prison.When leaving prison, linkage to community care is often challenging. Re-entry pathways from prison to community commonly involve community supervision. The existing infrastructure of community corrective services offers an avenue for providing continuity of care for people who did not access hepatitis C care in prison and expanded treatment coverage for those never previously imprisoned. Addressing co-occurring health need may also synergise with the goals of community corrections: improving health may reduce the risk of reoffending” (p. 3).
Translating Research into Practice
“...It is a challenging setting for the implementation of services to address competing healthcare need. Establishing clinical services within community corrections sites is made difficult by contrasting policy and systemic objectives of health versus corrections, a lack of infrastructure, systemic challenges of harnessing an administrative correctional system for healthcare purposes, and logistical barriers including reaching large numbers of people across a decentralised system. In the prison system a nurse-led health assessment is standard of care for prison reception in many countries and blood-borne virus screening is increasingly seen as integral to this health assessment” (p. 3).
“There is growing evidence for the feasibility and efficacy of low threshold, co-located and streamlined hepatitis C services in community settings for people who inject drugs. People on community corrections orders are a large and underserved at-risk population for hepatitis C which has received little attention to date. Adapted and novel models of care are needed to offer hepatitis C testing and treatment in these settings; these actions are critical in the quest for hepatitis C elimination” (p. 4).
Other Interesting Tidbits for Researchers and Clinicians
“Court- or parole board-ordered conditions of community supervision vary widely but almost always include requirements to report regularly to community correctional services (probation/parole officers). These reporting requirements are typically onerous for clients but also have the potential to be positively re-orientated and leveraged for healthcare engagement and retention” (p. 3).
“Offering simplified hepatitis C screening, assessment and treatment in non-healthcare settings attended by people at risk is made more feasible by recent technological advances in hepatitis C point-of-care diagnostic testing that allow same-day DAA prescription and efficient, rapid, and cost-effective pathways to treatment initiation. Point-of-care hepatitis C testing has been found to be feasible and acceptable to people who inject drugs and people in prison. Capillary blood sampling obtained by finger-prick for point-of-care testing is also more attractive to people who inject drugs than standard phlebotomy due to common venous access difficulties” (p. 4).
Additional Resources/Programs
As always, please join the discussion below if you have thoughts or comments to add!
