title: A descriptive model of patient readiness, motivators, and hepatitis C treatment uptake among Australian prisoners.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Justice Health Research Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Yap
authors.affiliation: National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Carruthers
authors.affiliation: Combined Universities of Rural Health, Geraldton, Western Australia, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Thompson
authors.affiliation: Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Cheng
authors.affiliation: National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Jones
authors.affiliation: Justice Health Research Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Simpson
authors.affiliation: Offender Health Services, Queensland Health, Queensland, Australia.
authors.forename: Alun
authors.initials: A
authors.lastname: Richards
authors.affiliation: 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.
authors.forename: Hla-Hla
authors.initials: HH
authors.lastname: Thein
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Haber
authors.affiliation: Inflammation and Infection Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lloyd
authors.affiliation: Justice Health Research Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Butler
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009042:Motivation; D011329:Prisoners / Q000523:psychology*; D036301:Qualitative Research; D012307:Risk Factors; D055815:Young Adult