Abstract
Objectives: Hepatitis C virus (HCV) poses a global public health threat. Prisons are a focus of prevention efforts due to high infection burdens. Expedition of treatment for incarcerated people is critical, as many are short- term sentenced. We evaluated point- of- care (PoC) HCV RNA testing in a maximum- security Scottish prison and assessed its impact on transition to treatment. We also evaluated costs and determinants of implementation.
Design: Mixed- methods evaluation of a single- centre care pathway pilot using National Health Service (NHS) data from 2018 to 2021. Descriptive statistics and survival analysis were undertaken. Cost analysis was assessed from a provider perspective. Healthcare staff participated in semistructured interviews and thematic analysis with a deductive approach was undertaken to identify implementation determinants.
Setting: A large maximum- security Scottish prison health centre administered by the NHS.
Participants: 296 incarcerated NHS patients (all men) and six NHS staff members (two men and four women).
Interventions: HCV testing using the Cepheid GeneXpert platform with Xpert HCV VL Fingerstick assay.
Outcome measures: The main outcome was survival (in days) from HCV test to treatment initiation. Secondary outcomes were cost- per- cure obtained and implementation determinants.
Results: During the pilot, 167 Xpert tests were administered, with an 84% completion rate, and treatment transition was superior for those who received it (p=0.014). Where PoC tests were administered, shorter survival to treatment was observed (19 vs 33 days: adjusted HR (aHR) 1.91 (1.03–3.55), p=0.040; 19 vs 50 days; aHR 3.76 (1.67–8.46), p=0.001). PoC was costlier than conventional testing. In qualitative analysis, most facilitators were observed among characteristics of individual domain while most barriers were noted in the inner setting.
Conclusions: Integrating PoC HCV RNA diagnosis into nurse- led HCV care in a maximum- security prison health centre shortens survival to HCV treatment. However, there are cost implications to this approach and multiple determinants that impact on implementation should be addressed.
Design: Mixed- methods evaluation of a single- centre care pathway pilot using National Health Service (NHS) data from 2018 to 2021. Descriptive statistics and survival analysis were undertaken. Cost analysis was assessed from a provider perspective. Healthcare staff participated in semistructured interviews and thematic analysis with a deductive approach was undertaken to identify implementation determinants.
Setting: A large maximum- security Scottish prison health centre administered by the NHS.
Participants: 296 incarcerated NHS patients (all men) and six NHS staff members (two men and four women).
Interventions: HCV testing using the Cepheid GeneXpert platform with Xpert HCV VL Fingerstick assay.
Outcome measures: The main outcome was survival (in days) from HCV test to treatment initiation. Secondary outcomes were cost- per- cure obtained and implementation determinants.
Results: During the pilot, 167 Xpert tests were administered, with an 84% completion rate, and treatment transition was superior for those who received it (p=0.014). Where PoC tests were administered, shorter survival to treatment was observed (19 vs 33 days: adjusted HR (aHR) 1.91 (1.03–3.55), p=0.040; 19 vs 50 days; aHR 3.76 (1.67–8.46), p=0.001). PoC was costlier than conventional testing. In qualitative analysis, most facilitators were observed among characteristics of individual domain while most barriers were noted in the inner setting.
Conclusions: Integrating PoC HCV RNA diagnosis into nurse- led HCV care in a maximum- security prison health centre shortens survival to HCV treatment. However, there are cost implications to this approach and multiple determinants that impact on implementation should be addressed.
Original language | English |
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Article number | e068604 |
Number of pages | 12 |
Journal | BMJ Open |
Volume | 13 |
Issue number | 4 |
DOIs | |
Publication status | Published - 10 Apr 2023 |
Keywords
- Hepatology
- INFECTIOUS DISEASES
- Organisation of health services
- PUBLIC HEALTH
- Public health
- QUALITATIVE RESEARCH
ASJC Scopus subject areas
- General Medicine
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Article of Outstanding Interest - INHSU Prisons bibliography 2023
Byrne, C. (Recipient), 14 Dec 2023
Prize: Other distinction