Facilitators and barriers to accessing hepatitis C treatment among justice-involved individuals during and after incarceration: A qualitative study

Author: Samir Kamat Sankeerth Kondapalli Shumayl Syed Ksenia Gorbenko Erik Groessl Joel Cantor Aakash Shah Matthew Akiyama

Theme: Social Science and Policy Research Year: 2021

Background: Despite effective antiviral therapy for HCV, justice-involved individuals face challenges in obtaining HCV treatment. This study aimed to identify the facilitators and barriers to being treated for HCV during and after incarceration. Methods: From July-November 2020, we conducted semi-structured interviews with 20 participants living with HCV who were formerly incarcerated in prisons and jails across New Jersey. Interviews were audiorecorded, transcribed, and thematically analyzed using NVivo qualitative software. Coding revealed distinct themes within correctional settings and after incarceration relating to facilitators and barriers to HCV treatment. Results: Participants included 4 women and 16 men who self-identified as White (n=10), Hispanic (n=6), or Black (n=4), and whose last incarceration ranged from 5 days-30 years. We identified the following themes: Within correctional settings, facilitators included having sufficient time to complete treatment and the availability of chronic care programs for HCV. Barriers included long waitlists and delays in advancing through pre-treatment work-up (e.g., blood tests, imaging). After incarceration, facilitators included abstinence from active substance use and linkage with reentry programs (e.g., halfway house or rehabilitation program) that coordinated treatment logistics, employed supportive staff, and incorporated health-related programming. Barriers included lack of insurance coverage and higher-ranking priorities (e.g., active substance use disorders and managing more immediate reentry challenges such as employment, housing, legal issues). Conclusion: Incarceration and the reentry period pose distinct facilitators and challenges to accessing HCV treatment. These findings can inform public health interventions to improve engagement in the HCV care continuum both during and after incarceration to assist in closing the gap of untreated justiceinvolved people living with HCV. Disclosure of Interest Statement: See example below: This project was supported by an Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship to SK (http://www.alphaomegaalpha.org/student_research.html).

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