Barriers and Facilitators to Implementing Point-of-Care RNA Testing For Hepatitis C Virus in a Scottish Prison Health Centre.

Author: Christopher Byrne Amy Malaguti Sarah K Inglis John F Dillon

Theme: Models of Care Year: 2022

Hepatitis C Virus (HCV) poses a global public health threat. Prisons have been a focus of prevention
efforts due to high HCV infection burdens relative to other populations. From 10 December 2019 to
05 March 2021, National Health Service (NHS) Tayside piloted point-of-care (PoC) HCV RNA testing
as part of routine care in a Scottish prison health centre to accelerate transition to treatment. We
sought to understand the barriers and facilitators of implementation to inform future work.
A Cepheid GeneXpert with the Xpert® HCV VL Fingerstick assay was integrated into on-site routine
HCV care at HMP Perth, Scotland. We undertook semi-structured interviews, informed by the
Consolidated Framework for Implementation Research (CFIR), with staff involved in implementing
the platform. Thematic analysis with a deductive approach was used to identify barriers and
facilitators to implementation, and these were allocated to CFIR domains.
Five interviews were completed with 6 individuals comprised of leadership, laboratory, and clinical
staff. Forty-one barriers and 29 facilitators were identified, totalling 70 determinants. Most barriers
were observed in the inner setting (n=13) of the CFIR and facilitators in characteristics of individuals
(n=8). This implied an underlying tension between facilitative aspects of individual knowledge, selfefficacy, and organisational culture, with challenges around leadership, readiness to implement, and
prioritisation of work. Key challenges were observed in interpreting and reporting results, manual
handling of test assays, and staffing pressures. Important facilitators included rapidity of results, the
evidence base for the platform, openness to change, and experience with other PoC test types.
This evaluation highlighted multiple determinants to implementation which may inform similar
pilots in other prison settings. Particular attention should be paid to full-spectrum staff training on
the testing platform, improved integration with conventional NHS reporting systems, and optimised
workflow and workload prioritisation.
Disclosure of Interest Statement:
Cepheid UK Ltd provided diagnostic platforms and test assays free of charge and provided funding to
support a fixed-term part-time coordinator to facilitate this NHS pilot project. CJB, AM and SKI have
no disclosures. JFD reports grants and personal fees from AbbVie; grants and personal fees from
Gilead; grants and personal fees from MSD, outside the submitted work.

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