'I just keep thinking I haven't got it because I'm not yellow': a qualitative study of the factors that influence the uptake of Hepatitis C testing by prisoners.
BACKGROUND
Hepatitis C viral (HCV) infection is a significant public health problem. In the UK, an estimated 200,000 individuals have active HCV infection, most of whom are injecting drug users (IDUs). Many IDUs spend time within the prison system therefore screening for HCV infection in this setting is important. However, uptake of testing within prisons is very low.


METHODS
Qualitative interview study. 30 interviews with 25 male and 5 female prisoners with a history of injecting drug use.


RESULTS
Personal and institutional barriers to uptake of testing for HCV were identified. Personal barriers included: prisoners' fears and lack of knowledge about HCV, low motivation for testing, lack of awareness about the testing procedure, and concerns about confidentiality and stigma. Institutional barriers included: the prisons' applications procedure for testing, inadequate pre- and post-test discussion, lack of pro-active approaches to offering testing, and lack of continuity of care on discharge and transfer.


CONCLUSIONS
This study highlights potential areas of development in the management of HCV in prisons. Further research is needed to evaluate care pathways for HCV in the prison setting and to develop and assess interventions to improve the uptake of testing for HCV by prisoners.
Khaw
Fu-Meng
FM
North East Health Protection Unit, Health Protection Agency, Institute of Pathology, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, UK. f.m.khaw@ncl.ac.uk
Stobbart
Lynne
L
Murtagh
Madeleine J
MJ
D000328:Adult; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011329:Prisoners / Q000523:psychology*; D011330:Prisons / Q000592:standards* / Q000706:statistics & numerical data; D036301:Qualitative Research; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000821:virology