Abstract
Background: People on community corrections orders are at high-risk for hepatitis C but opportunities for hepatitis C care may be missed due to poor integration of prison-based healthcare. The C No More study is a pilot feasibility study of point-of-care hepatitis C testing and rapid treatment initiation delivered adjacent to community corrections settings in Melbourne, Australia, via a mobile, nurse and peer-led, low-threshold model of care.
Methods: We conducted a mixed methods evaluation using Levesque's Conceptual Framework of Access to Health to understand participants’ experiences and perspectives on the accessibility of this model of care. Interviewer-administered surveys were conducted with all participants after enrolment and initial testing, and qualitative in-depth interviews were conducted with a sample of those who completed the survey.
Results: 500 participants completed the survey, and 20 participants undertook in-depth interviews. Both quantitative and qualitative results indicated that participants found the C No More service approachable and accessible due to the informal outreach setting, the involvement of peer workers, and the convenient location of service delivery. Participants reported feeling comfortable seeking care in the van and found the service appropriate and easy to engage with due to the fingerstick point-of-care testing and individualised support provided by the nurse.
Conclusion: Multiple elements of the C No More model increased client-perceived service accessibility, including being located close to government services, point-of-care testing, and the person-centred, peer-based and non-judgemental nurse-led care provided. This study supports the implementation of other peer and nurse-led models of hepatitis C care in similar settings.
| Original language | English |
|---|---|
| Article number | 104785 |
| Journal | International Journal of Drug Policy |
| Volume | 139 |
| Early online date | 26 Mar 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 26 Mar 2025 |
Acknowledgements
The authors gratefully acknowledge the people who participated in the C No More study. The authors acknowledge the National Point of Care Testing Program and the Kirby Institute for their support. The authors gratefully acknowledge Pinch-a-poo and Thread Together for their donations and Hepatitis Queensland for their support. The authors acknowledge the Victorian Department of Justice and Community Safety, and the staff and management of the community corrections sites that the mobile service was located near.Funding
This study was funded partially by Gilead sciences Pty Ltd via an independent medical grant, by St Vincent's Hospital Inclusive Health Award, and by National Health and Medical Research Council Synergy Grant (GTN 2027497). The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program.
Keywords
- Blood-borne viruses
- Cascade of care
- Community corrections orders
- Community sentences
- Correctional setting
- Hepatitis C virus
- Mobile services
- Nursing
- Opioid agonist therapy
- Point-of-care testing
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Health Policy
