Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting.

Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting. Qualitative study with prison population. Hepatitis C (HCV) treatments with direct-acting antiviral therapy (DAA) are an easy and effective option among people who inject drugs (PWID). However, difficulties in accessing and monitoring treatment in community services and dropouts on release from prison are detected among PWID. For this reason, the aim of the study is to know the access barriers in the diagnosis and treatment of HCV in community health services. An exploratory qualitative study was carried out through semi-structured interviews with 33 PWID recruited in a pre-trial detention prison in Barcelona. The information obtained was analysed using grounded theory. Among PWID sub-population entering prison, personal barriers are related to intense drug use, lack of interest and ignorance of HCV infection and treatment, as well as being in a situation of social exclusion. In relation to health providers, they reported receiving little information, the existence of language barriers in migrants, not receiving screening and treatment proposals, and having poor interactions with some professionals. Systemic barriers were expressed related to the health system circuit being complicated, perceiving little comprehensive care and lack of community support. It is recommended to intensify prevention and treatment campaigns, promoting drug substitution programmes than current ones, improve health education, make the diagnosis and treatment process more flexible, and promote social policies and holistic care for greater coverage of the needs of PWID.

The priorities for a prisoner are food, being able to talk to their family, and taking a shower: the experiences of prisoners placed in emergency isolation due to COVID-19 in a Catalan prison.

PURPOSE: This study aims to learn about the experiences of inmates who experienced long periods of isolation due to a COVID-19 outbreak in the Brians 1 penitentiary centre. This approach is relevant, as it sought to understand the experiences from the perspective of the prisoners during periods of isolation. The aim was to gain in-depth knowledge, based on the idiosyncrasies of this population, of their emotions and coping strategies in the prison context. This information that may be useful to prison institutions and prison primary healthcare teams to guide the organisation in future health emergencies involving the isolation of prisoners. DESIGN/METHODOLOGY/APPROACH: A qualitative interpretative phenomenological study was conducted. Face-to-face semi-structured interviews were conducted with a sample of 30 people who had undergone a period of isolation due to a COVID-19 outbreak in one or two of the last two outbreaks at the Brians 1 (Barcelona) prison in 2022, in the days following periods of social isolation. The interviews were transcribed and analysed using the content analysis approach, and were coded using the NVivo 12 qualitative software. The credibility and validity of the data analysed were increased through triangulation at different levels. In this study, data was collected from a heterogeneous sample of prisoners, capturing different views among the prison population. FINDINGS: This research gave us the opportunity to collect prisoners' accounts of isolation due to COVID-19, in which it became clear that it conditioned the management of time and space in daily prison life. The restrictions amplified negative emotions such as anxiety, stress and restlessness and led to disruptions in communication with the outside world, daily prison activities and judicial processes. Despite these changes, the prisoners understood the imperatives of isolation and the need to adapt to the new situation for a limited period of time. Faced with the detrimental effect on their well-being, the prisoners employed coping strategies focused on emotional management, social supports and occupational engagement. RESEARCH LIMITATIONS/IMPLICATIONS: This study is subject to several limitations related to the characteristics of the sample. No women participated in the study as the modules studied were exclusively for men. People with impaired cognitive abilities, were not included. With regard to the method, it is understood that conducting the interviews in the days after the isolation may have influenced the content and enthusiasm of the participants. Despite these limitations, we are confident that the data triangulation may have given us reliable insight that will further our knowledge of prisoners' experiences in this type of situation. ORIGINALITY/VALUE: The issue of the negative impact of restrictive measures in the prison environment has rarely been studied from the perspective of prisoners. To the best of the authors' knowledge, this study is the first to provide qualitative data on the experiences of prisoners during periods of social isolation due to COVID-19 outbreaks in prisons in Catalonia (Spain). The narratives allowed the authors to determine what impact the restrictions had on the emotional well-being and daily life of the prison population, information that can help prison institutions and healthcare teams understand how prisoners experienced this type of situation. The authors were also able to carry out an in-depth study of the coping strategies used by the prisoners to deal with negative emotions during the COVID-19 outbreaks, which may serve to guide the organisation of material and human resources in future emergencies or regimented situations involving social isolation.

Incidence and molecular epidemiology of hepatitis C virus reinfection in prisons in Catalonia, Spain (Re-HCV study).

Hepatitis C virus (HCV) reinfection may hamper HCV elimination in prisons. We aimed to (i) determine the reinfection rate in people treated for HCV in Catalan prisons, (ii) measure reinfection in people entering prisons, and (iii) characterize the molecular epidemiology of HCV in prisons and people who inject drugs (PWID) in the community. Re-HCV was a prospective study in eight prisons (2019-2020) including two groups: (1) people cured with treatment in prison and followed-up every 6 months, and (2) people testing HCV-RNA positive at incarceration. Bio-behavioral data were collected. HCV isolates were sequenced and phylogenetically analyzed with those of PWID in the community. Reinfection follow-up after treatment was achieved in 97 individuals (103.05 person-years). Two reinfections were detected, resulting in an incidence ≤ 10/100 person-years. Among people entering prison, 2% (359/17,732) were viremic, of which 334 (93.0%) were included, and 44 (13.5%) presented with reinfection (84.7% being PWID). Frequently, HCV isolates in prisons and PWID in the community were phylogenetically related. Although HCV reinfection is low after treatment, it is common in people entering Catalan prisons. To maintain a low HCV prevalence in prisons, harm-reduction services and test-and-treat programs for PWID should be strengthened both inside and outside prisons.