Factors influencing compliance with Hepatitis C treatment in patients transitioning from prison to community—A summary scoping review

It is well‐established that prevalence of Hepatitis C (HCV) infection in prisoners is disproportionately higher than in the general population. While developments in screening and treatment for HCV have enabled greater detection and treatment in prison, release is a high‐risk time for HCV infected prisoners returning to the challenges of community living. A scoping review was conducted to examine the evidence on individual, provider and system level factors that influence compliance with HCV treatment in patients transitioning from prison to community. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Electronic peer‐reviewed databases were searched in February 2022: 140 articles were initially identified of which seven were included in the final review. Six key themes characterized the literature: education, case management and discharge planning, hepatology in‐reach nurses, transition clinics, primary care providers and system wide approach. This summary scoping review highlights the paucity of research in this area. There is a need for experimental research to investigate specific interventions, and to understand HCV care‐specific barriers and facilitators. A multi‐pronged approach is needed to address barriers to healthcare services in general but also specific barriers relating to HCV. Factors that facilitate compliance should also be recognized and amplified across regional HCV elimination strategies.

compliance with HCV treatment in patients transitioning from prison to community.
Electronic peer-reviewed databases were searched: 140 articles were initially identified of which seven were included in the final review. Five key themes were identified, described below and in

| Education
Education was a key theme that appeared in four studies included in this review. [1][2][3][4][5] Authors noted the importance of a multi-layered education provision:

| Patient education
There was an overall lack of patient knowledge of the disease process and associated health implications. Fear of HCV treatment was a common among prisoners, with concerns that it was invasive with an unfavourable side effect profile. On-site provision of disease-specific education by healthcare providers to prison staff and prisoners was identified as an important facilitator to improving compliance with HCV treatment upon release.

| Case management and discharge planning
The role of comprehensive case management and discharge planning was a recurring theme. 1,2,3,5,6 Development of structured transition plans should incorporate several key elements to provide the greatest chance for linkage to care:

| Discharge planning
A comprehensive multi-disciplinary discharge plan could mitigate competing priorities at the time of release that impact not only an individual's ability to access HCV treatment but also their ability to reorientate themselves back into society in a meaningful way.
High prison turnover and unplanned or unforeseen prison transfers make it difficult to effectively plan a comprehensive discharge.
Developing inter-establishment protocols for care continuity would allow receiving facilities to quickly identify the medicinal needs of new prisoners and more time to focus on case management. 1

| Case management
The presence of social support post incarceration has been demonstrated to facilitate linkage to HCV care. Many individuals in contact with the criminal justice system experience fractious interpersonal relationships. Thus, the role of case managers and support from peer navigators should not be overlooked. This can facilitate ongoing HCV care by fostering social supports for an otherwise marginalized individual.

| Transportation
A recent qualitative study indicated that transportation to healthcare facilities was a major barrier to HCV treatment continuation in the community. 7 A lack of transportation on release from prison, untimely prison transfers and difficulties establishing a secure base upon release make it difficult for prisoners to avail of HCV treatment even if they were initially motivated to complete treatment. Community hubs, specialist in-reach services or transitional care facilities have all been suggested as a means of navigating these logistical barriers.

| Hepatology in-reach nurses
Prisoners and ex-prisoners describe relationships with in-reach nurses as one based on trust, familiarity and support. They are an the role of the in-reach nurse was viewed as positive by prisoners, but consideration needs to be given to the role of specialist in-reach nurses both in terms of their provision of medication and more indepth psychosocial support. However, it is important to note that primary care providers in the UK are already experiencing significant strain, with declining GP numbers, rising demand and struggles to recruit and retain staff. Any initiative to extend the remit of primary care to provision of transitional care for released prisoners must be part of a system wide discussion about responsibility and shared care arrangements.

| A system wide approach
For many prisoners, release from prison is as an extremely chaotic

| SUMMARY
Infection with HCV in prisoners is often confounded by a myriad of psychosocial issues. Focussing purely on HCV treatment pathways without addressing the social, structural and economic determinants of health will be less effective in reducing the overall burden of HCV.
Individual factors such as education, access to stable housing, meaningful employment and social support must be addressed to create the conditions required for HCV compliance during the transitional phase. Provision of services for co-existing mental illness or substance misuse has been shown to positively impact an individual's ability to engage with HCV treatment.
Policy makers, healthcare providers, public health experts and justice departments must work synergistically to develop and evaluate a transitional care system for prisoners. This approach has the potential to improve healthcare access not only for this cohort but for other marginalized and socially excluded populations.

CO N FLI C T O F I NTE R E S T
None declared.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.

R E FE R E N C E S S U PP O RTI N G I N FO R M ATI O N
Additional supporting information can be found online in the Supporting Information section at the end of this article.