5. Harm reduction interventions and viral hepatitis elimination in prison: models of care and barriers for implementation

Coverage of essential prevention and control services and adequate monitoring schemes for viral hepatitis are often sub-optimal in prison settings. Yet, evidence accumulating from EU/EEA and overseas shows that targeted interventions are feasible and effective in reducing viral hepatitis burden and decreasing virus circulation among people living in prison and the community at large. Identifying and disseminating models of care and prevention interventions implemented in prison institutions in the EU/EEA may promote transferability and improvement of prison health quality in the region.

Desk review of available evidence to identify models of care; targeted survey and interviews to healthcare staff working in prison institutions in the EU/EEA to understand what are the barriers for implementation good care interventions; expert opinion of EU experts. The project is currently ongoing, including the selection of prisons and EU experts.

The following models of care were collected: HCV micro-elimination in prison; transitional care for HCV treatment or HBV prevention/treatment; HCV or HBV care services tailored to women living in prison; HBV or HAV/HBV vaccination in prison settings. Harm reduction and drug treatment services in the prison are essential at all steps of the prevention and continuum of care. Among barriers identified were: engagement of people living in prison and prison governance structure, availability of infrastructural and human resources, daily prison organisation, inter-sectorial collaboration within prison and between prison and community services and training for prison staff and lack of systematic monitoring.

Evidence of effective and acceptable interventions in prison to prevent and control viral hepatitis is essential to foster inclusion of prison setting within national elimination programmes. Intra-EU benchmarking may help promoting awareness, allocation of adequate resources and monitoring of impact and ultimately the achievement of the elimination goal.