title: A stepped wedge cluster randomized control trial of dried blood spot testing to improve the uptake of hepatitis C antibody testing within UK prisons.
abstract: BACKGROUND
  The prevalence of hepatitis C (HCV) is elevated within prison populations, yet diagnosis in prisons remains low. Dried blood spot testing (DBST) is a simple procedure for the detection of HCV antibodies; its impact on testing in the prison context is unknown.
  
  
  METHODS
  We carried out a stepped-wedge cluster-randomized control trial of DBST for HCV among prisoners within five male prisons and one female prison. Each prison was a separate cluster. The order in which the intervention (training in use of DBST for HCV testing and logistic support) was introduced was randomized across clusters. The outcome measure was the HCV testing rate by prison. Imputation analysis was carried out to account for missing data. Planned and actual intervention times differed in some prisons; data were thus analysed by intention to treat (ITT) and by observed step times.
  
  
  RESULTS
  There was insufficient evidence of an effect of the intervention on testing rate using either the ITT intervention time (OR: 0.84; 95% CI: 0.68-1.03; P = 0.088) or using the actual intervention time (OR: 0.86; 95% CI: 0.71-1.06; P = 0.153). This was confirmed by the pooled results of five imputed data sets.
  
  
  CONCLUSIONS
  DBST as a stand-alone intervention was insufficient to increase HCV diagnosis within the UK prison setting. Factors such as staff training and allocation of staff time for regular clinics are key to improving service delivery. We demonstrate that prisons can conduct rigorous studies of new interventions, but data collection can be problematic.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number Register (ISRCTN number ISRCTN05628482).
authors: 1 Microbiology Department, Public Health Wales, Ysbyty Gwynedd, Bangor, Wales, UK noel.craine@wales.nhs.uk.
authors: Noel
authors: N
authors: Craine
authors: 2 North Wales Organisation for Randomised Trials in Health and Social Care, Bangor University, Gwynedd, Wales, UK.
authors: Rhiannon
authors: R
authors: Whitaker
authors: 3 Health Protection, Public health Wales, Cardiff, Wales, UK.
authors: Stephanie
authors: S
authors: Perrett
authors: 2 North Wales Organisation for Randomised Trials in Health and Social Care, Bangor University, Gwynedd, Wales, UK.
authors: Lu
authors: L
authors: Zou
authors: 4 School of Social and Community Medicine, University of Bristol, England, UK.
authors: Matthew
authors: M
authors: Hickman
authors: 3 Health Protection, Public health Wales, Cardiff, Wales, UK.
authors: Marion
authors: M
authors: Lyons
mesh_terms: D016000:Cluster Analysis; D059788:Dried Blood Spot Testing / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006526:Hepatitis C / Q000097:blood* / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008297:Male; D011329:Prisoners / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D006113:United Kingdom
chemical_list: D018937:Hepatitis C Antibodies