“I don’t understand why things like that aren’t mandatory”: people in prisons’ views on universal opt-out and point-of-care testing in prison

Background: Hepatitis C care is well established in Australia’s prisons; in 2022 one-third of all treatments nationally were initiated in prisons. However, to reach elimination goals alterations to existing approaches are necessary to reach more people living with hepatitis C. Structural and social barriers to accessing in-prison hepatitis C testing remain; universal opt-out and point-of-care testing can likely mitigate some of these barriers and are inconsistently implemented in Australia’s prisons.

Methods: Qualitative in-depth interviews were conducted with 25 participants in one women’s prison (n=9) and two men’s prisons (n=16) in Victoria, Australia between December 2022 and May 2023. Interviews examined participant’s hepatitis C testing and treatment experiences and knowledge, and perceived barriers and enablers to accessing prison-based testing. Interview data were analysed thematically.

Results: Participants were aged 25-50 years and four identified as Aboriginal. Most (n=17) were sentenced. Overwhelmingly participants believed universal opt-out and point-of care hepatitis C testing could help remove barriers to testing and treatment uptake in prisons. Opt-out testing was perceived as a solution for addressing stigmatising attitudes, poor knowledge about hepatitis C and eliminate arduous barriers to hepatitis C testing in prison–especially for those unaware about hepatitis C. Point-of-care testing at prison reception was endorsed for being quick and easy, addressing the hassle of making an appointment, and alleviating anxiety of waiting for pathology and results. Several participants described challenging venous access creating hesitancy for standard blood testing; point-of-care testing was also considered one way to avoid this.

Conclusion: Participants in our study were overwhelmingly supportive of adopting prison-based universal opt out testing. Our study demonstrates how providing universal opt out hepatitis C testing in Australian prisons could help address current access barriers hindering hepatitis C elimination.

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