Theme: Models of Care Year: 2024
Background: Worldwide, people incarcerated in prisons have histories of injection drug use and active HCV infection. HCV micro-elimination in prisons is an effective strategy to treat people who use drugs (PWUD). Locally in Victoria, British Columbia, administrative barriers limited HCV testing and treatment – only 4-6 blood draws a week are done by local lab for over 200 inmates and navigating access to HCV medications was complex in the past. A lack of communication between clinical staff case managing HCV treatment from prison to community led to HCV RNA positive individuals being lost to follow up.
Description of model of care: CACHC is an inner-city, interdisciplinary primary health care centre serving 7300 clients living with chronic mental health challenges, problematic substance use, and homelessness. Preceptorships and long-term relationship building has improved prison clinical staff knowledge around HCV treatment. The CACHC HCV treatment nurse in collaboration with the prison nurse hold HCV testing ‘blitzes’ on prison units and offer phlebotomy for STBBI screening and HCV pre-treatment bloodwork. Clients who test HCV RNA+ start on HCV treatment and if released from prison before completion, the CACHC HCV treatment nurse follows the client in the community.
Effectiveness: To date 123 people were tested: 31 tested HCV AB+, 7 tested RNA+, 7 started on treatment, with 2 confirmed SVR. Maintaining contact with clients once they leave prison is challenging and SVR rates reflect this. Ten other people have been supported to start treatment through increased inter-agency communication.
Conclusion and next steps: This innovative and novel approach to HCV therapy with PWUD in prisons was able to test and treat HCV more effectively, both in and out of prisons. CACHC and prison staff have established closer relationships, and reduced barriers to reach and maintain continuity of care with PWUD and others who remain untreated for HCV.