Increasing HCV testing and treatment uptake among women in the criminal justice system: A specialist peer-led model

Author: Leila Reid, Julia Sheehan

Theme: Models of Care Year: 2023

Women in the criminal justice system (CJS) often have complex, intersecting needs and experiences of HCV-related stigma. The UK CJS sees significant levels of HCV testing and treatment refusal linked to low knowledge of HCV transmission and misinformation about treatment. 

Description of model of care/intervention:
Since 2018, specialist workers with lived experience of HCV and the CJS (peers) have been embedded in England’s women’s prison estate. They find women with HCV and support them through treatment. 
Peer teams educate staff and prisoners, deliver whole-prison testing, test individuals as needed and support access to treatment when required. They also recruit and train volunteer HCV champions, building a consistent presence within each prison.
Peer staff hold keys, enabling them to move around prisons as needed and without the accompaniment of prison officers. This allows a range of interventions – outreach on landings, support with contact tracing, engaging people refusing testing – to discretely take place.   

Peer staff work closely with healthcare and build trusting relationships with many women within their prisons. In 2022/23 they tested 878 women (England’s female prison population is c. 3,000) and identified 142 with HCV RNA. All 142 were supported to start treatment. 

Conclusion and next steps:
This program offers wrap around care to women in the CJS utilising peers’ lived experience and excellent healthcare partnerships. In 2021 they began working approved premises – linking into the probation system for women outside prisons. As well as relatively high HCV rates, the team has seen significant HCV reinfection; they are now trialling community-linked contact tracing, and hope to pilot needle exchange on release soon. 

Disclosure of Interest Statement: 
This programme received funding from Mary Kinross Charitable Trust. HCT received funding for associated work from Gilead, Abbvie, MSD, HM Prison Service & NHS England. 

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