New BASHH Research Fellow joins National Health & Justice Team, Public Health England: Exploring factors that affecting progression along the HCV Care Cascade in English Prisons

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I am a doctor in training in Sexual Health and HIV and I usually work in London. I am excited to now start working at Public Health England’s (PHE) National Health and Justice Team on a one year fellowship scheme offered jointly by BASHH (British Association for Sexual Health and HIV) and PHE.
 
My area of interest is Hepatitis C virus (HCV) in prisons and the “cascade of care” that comprises the steps from diagnosis through to cure. People in prison are more likely than their peers in the community to be infected with HCV due to over-representation of people who inject drugs in prisons. Injecting drug use is the single most important risk factor for infection with HCV in England. Despite this, levels of testing for infection have traditionally been too low. PHE working with NHS England and HM Prison & Probation Service have been implementing an opt-out testing policy for blood-borne viruses (BBVs) which has increased level of testing (from a baseline of 4% to about 20% of all prisoners). But only a small proportion of people living with HCV in English prisons actually access HCV care, treatment, and achieve cure. This is for a multitude of reasons which are not fully understood at present. Reasons might include stigma amongst incarcerated persons towards testing, competing priorities for prison staff and healthcare staff, and the relatively frequent movement of offenders between as well as out of prisons.
 
My research this year will used mixed methods to address the HCV cascade of care in English prisons and will be completed with a few approaches:
 
1. I will use a questionnaire to gauge opinion amongst a group of stakeholders in the HCV care cascade in prisons, predominantly in prisons in the South East of England
2. I will conduct semi-structured interviews with stakeholders – advocacy groups for HCV, healthcare providers both in prisons and those who care for inmates after release, non-healthcare staff in prisons, and stakeholders on ODN (Operational Delivery Network) boards (who commission HCV treatments). I will analyse for emergent themes.
3. I aim to provide context to these qualitative data with two quantitative analyses – the first being to review, at a prison level, which prison factors are associated with higher testing and referral rates for treatment. The second will be to review the data at a single ODN and describe the population of incarcerated people who have been offered treatment for HCV.