Identifying Barriers and Enablers to Opt-Out Hepatitis C Virus Screening in Provincial Prisons in Quebec, Canada: A Qualitative Study With Correctional Stakeholders Using The Consolidated Framework For Implementation Research

Author: Guillaume Fontaine Ana Saavedra Ruiz Andrea M. Patey Jeremy M. Grimshaw Justin Presseau Joseph Cox Camille Dussault Nadine Kronfli

Theme: Social Science & Policy Research Year: 2022

Background: Implementing universal opt-out hepatitis C virus (HCV) screening in correctional settings
requires an in-depth understanding of the roles and perspectives of stakeholders at different levels of
government administration. We sought to identify barriers and enablers to implementing opt-out HCV
screening from the perspective of correctional stakeholders and describe the related interdisciplinary
decision-making process in Quebec provincial prisons.
Methods: We conducted a qualitative study using the Consolidated Framework for Implementation
Research (CFIR). CFIR includes five domains (Intervention characteristics, Outer setting, Inner setting,
Characteristics of individuals, Process) and 39 constructs/determinants of implementation, primarily at an
organizational level. Semi-structured interviews were conducted using videoconference or telephone
(due to COVID-19 restrictions) with correctional stakeholders from government ministries, regional public
health, and regional health authorities. Directed content analysis was used and key CFIR constructs were
Results: From April 16 to May 14, 2021, eight correctional stakeholders were interviewed. Twenty-three
CFIR constructs in four domains (Intervention characteristics, Outer setting, Inner setting, and Process)
were identified; ten were identified as enablers, nine as barriers, and four as neutral factors. Key enablers
included a desire for change (construct: Tension for change), and a willingness of correctional health
services managers to improve care for people who are incarcerated (construct: Patient Needs and
Resources). Key barriers included a lack of political will (construct: External policy and incentives), limited
human, financial, and material resources (construct: Available resources), and a lack of consideration of
implementation issues distal to screening (constructs: Trialability, Planning). The decision-making process
vis-à-vis HCV care in Quebec correctional settings was found to be hierarchical, with interdependencies
complicating policy formulation and implementation.
Conclusion: Implementation of opt-out HCV screening in Quebec provincial prisons will require policy
changes, multi-level stakeholder engagement, and a thorough assessment of barriers and enablers to
linkage to care and treatment uptake.
Disclosure of Interest Statement: GF, ASR, AMP, JMG, JP, and CD have no conflict of interest to declare.
NK reports research funding from Gilead Sciences, advisory fees from Gilead Sciences, ViiV Healthcare,
Merck and Abbvie, and speaker fees from Gilead Sciences, Abbvie and Merck, all outside of the submitted
work. JC reports research funding and advisory fees from Gilead Sciences and ViiV Healthcare, all outside
of the submitted work.

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