Identifying Barriers and Enablers to Opt-Out Hepatitis C Virus Screening in Provincial Prisons in Quebec, Canada: A Qualitative Study With Prison-Based Healthcare Professionals Using The Theoretical Domains Framework

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: Microelimination of hepatitis C virus (HCV) in correctional settings is dependent on offering
systematic HCV screening. We sought to identify barriers and enablers of implementing opt-out HCV
screening in provincial prisons in Quebec, Canada from the perspective of prison-based healthcare
professionals (HCPs).
Methods: We conducted a qualitative study using the Theoretical Domains Framework (TDF) to identify
factors influencing HCPs’ likelihood of offering opt-out screening in provincial prisons. The TDF synthesizes
constructs from 33 behaviour change theoriesinto 14 domains representing individual, socio-cultural, and
environmental influences on individual behaviours. Semi-structured interviews were conducted using
videoconference or telephone (COVID-19 restrictions) with physicians and nurses from four prisons with
different HCV screening strategies (i.e., opt-in, risk-based, or on-demand). Directed content analysis was
used and key TDF domains were identified.
Results: From April 16 to May 14, 2021, eight HCPs (four physicians, four nurses) were interviewed. Six
TDF domains relevant to implementation of opt-out HCV screening were identified: Beliefs about
consequences (mixed = barrier and enabler), Environmental context and resources (barrier), Social
influences (barrier), Optimism (mixed), Emotions (mixed), and Behavioural regulation (barrier). While
most HCPs were enthusiastic about the outcomes of opt-out screening (e.g., detecting more cases,
decreasing HCV transmission) many were concerned about the potential for increased workload, the
additional collaboration with correctional guards, and the lack of resources (e.g., office space, healthcare
personnel, etc.) and collaboration with correctional employees.
Conclusion: The barriers and enablers identified indicate HCP interest in implementing opt-out HCV
screening in Quebec provincial prisons, but simultaneously suggest the importance of considering a wide
range of factors (e.g., human, financial, and material resources) before implementation.
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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