A descriptive model of patient readiness, motivators, and hepatitis C treatment uptake among Australian prisoners

Lorraine Yap; Susan Carruthers; Sandra Thompson; Wendy Cheng; Jocelyn Jones; Paul Simpson; Alun Richards; Hla-Hla Thein; Paul Haber; Andrew Lloyd; Tony Butler

doi:10.1371/journal.pone.0087564

A descriptive model of patient readiness, motivators, and hepatitis C treatment uptake among Australian prisoners

PLoS One. 2014 Feb 27;9(2):e87564. doi: 10.1371/journal.pone.0087564. eCollection 2014.

Authors

Affiliations

¹ Justice Health Research Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
² National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
³ Combined Universities of Rural Health, Geraldton, Western Australia, Australia.
⁴ Royal Perth Hospital, Perth, Western Australia, Australia.
⁵ Offender Health Services, Queensland Health, Queensland, Australia.
⁶ Justice Health Research Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁷ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
⁸ Inflammation and Infection Research Centre, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

Background: Hepatitis C virus infection (HCV) has a significant global health burden with an estimated 2%-3% of the world's population infected, and more than 350,000 dying annually from HCV-related conditions including liver failure and liver cancer. Prisons potentially offer a relatively stable environment in which to commence treatment as they usually provide good access to health care providers, and are organised around routine and structure. Uptake of treatment of HCV, however, remains low in the community and in prisons. In this study, we explored factors affecting treatment uptake inside prisons and hypothesised that prisoners have unique issues influencing HCV treatment uptake as a consequence of their incarceration which are not experienced in other populations.

Method and findings: We undertook a qualitative study exploring prisoners' accounts of why they refused, deferred, delayed or discontinued HCV treatment in prison. Between 2010 and 2013, 116 Australian inmates were interviewed from prisons in New South Wales, Queensland, and Western Australia. Prisoners experienced many factors similar to those which influence treatment uptake of those living with HCV infection in the community. Incarceration, however, provides different circumstances of how these factors are experienced which need to be better understood if the number of prisoners receiving treatment is to be increased. We developed a descriptive model of patient readiness and motivators for HCV treatment inside prisons and discussed how we can improve treatment uptake among prisoners.

Conclusion: This study identified a broad and unique range of challenges to treatment of HCV in prison. Some of these are likely to be diminished by improving treatment options and improved models of health care delivery. Other barriers relate to inmate understanding of their illness and stigmatisation by other inmates and custodial staff and generally appear less amenable to change although there is potential for peer-based education to address lack of knowledge and stigma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Australia / epidemiology
Cross-Sectional Studies
Female
Hepatitis C / drug therapy
Hepatitis C / epidemiology*
Humans
Male
Middle Aged
Models, Theoretical*
Motivation*
Prisoners / psychology*
Qualitative Research
Risk Factors
Young Adult

Grants and funding

This study was supported by a National Health and Medical Research Council (NHMRC) grant (No. 594444). Tony Butler is supported by an Australian Research Council (ARC) Future Fellowship (No. FT0991864). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Material in this paper cannot be considered as either endorsed by or an expression of the policies or views of the departments of corrective services.