Why did we develop this toolkit?
Hepatitis C (HCV) disproportionately affects people in prison. It is estimated that 1.5 million people in prison globally are living with HCV (Dolan et al., 2016), largely due to the criminalisation of drug use, resulting in the over-incarceration of people who inject drugs. (Altice et al., 2016; Larney et al., 2013; WHO, 2014). People in prison often continue to inject drugs while incarcerated, and due to limited access to harm reduction programs like opioid agonist therapy (OAT), and needle and syringe programs (NSP) the risk of HCV acquisition and also re-infection in prison remains high.
Prison-based HCV interventions provide a unique opportunity for treatment and care for this marginalised population who do not commonly access this type of healthcare in the community. However, access to prison-based HCV testing and treatment services remains low globally. Many developed countries offer universal subsidised access to hepatitis C testing and treatment to its citizens, but fail to do so for prisoners. Other developed countries offer access to testing and treatment through user pays mechanisms such as via health insurance to the general community, but fail to do so in the correctional setting. This discordance is attributable to obstacles at every level – from political will and policy direction, to custodial and health organisational implementation practices, and even to local custodial and health administrators’ operational approaches.
Further efforts are needed to implement and scale-up hepatitis C services globally in the prison setting. Given prison-based HCV testing and treatment will likely be key to national and global elimination efforts, INHSU Prisons, in collaboration with experts from around the globe, have developed this Toolkit to support these efforts. The toolkit provides practitioners, NGOs and communities with evidence-based resources to enhance their advocacy efforts and increase hepatitis C testing and treatment services for prisoners across low, middle and high income country settings.
About the development process
Developed over the course of a 2 year period, INHSU Prisons worked collaboratively with stakeholders across low, middle and high income settings, working in funding, policymaking and healthcare provision related to the prisons, to inform the evidence base for this toolkit.
The toolkit employed co-design principles to ensure it met the needs of the intended target audience. To learn more about the development process, click HERE.
Evaluation
The project team will be conducting an evaluation of the utility and uptake of the toolkit between October 2024 and July 2025. If you are interested in being involved in this process and sharing any stories of how you have used the toolkit in your country to advocate for hepatitis services in prisons, please email [email protected]
About INHSU Prisons
INHSU Prisons, is a Special Interest Group of the International Network on Health and Hepatitis in Substance Users (INHSU) for members who would like to participate in scientific knowledge and information exchange, knowledge translation, and advocacy for enhanced hepatitis care in custodial settings. For more information about INHSU Prisons, click here.
Acknowledgements
Project team:
Dr Matthew Akiyama, Albert Einstein College of Medicine / Montefiore Medical Centre, New York, USA
Dr Nadine Kronfli, McGill University Health Centre, Montreal, Quebec, Canada
Professor Andrew Lloyd, Australian National Prisons Hepatitis Network / The Kirby Institute UNSW Sydney, Australia
Yumi Sheehan, Australian National Prisons Hepatitis Network / The Kirby Institute UNSW Sydney, Australia
Dr Shelley Walker, Research Fellow, National Drug Research Institute (NDRI) | Burnet Institute
Olivia Dawson, Program Manager, the International Network on Health and Hepatitis in Substance Users (INHSU)
The project team would like to extend its sincere thanks and appreciation to all those who participated in the development of this toolkit, the survey respondents, the qualitative interviewees, the INHSU Prisons Executive Committee and all those who gave their time as part of the co-design and review process.
This project was funded by a grant from Gilead Sciences. Gilead Sciences had no input into the content, tone, emphasis or selection of the models profiled. We are grateful for their support.