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Blackaby J, Byrne J, Bellass S, Canvin K, Foy R. Interventions to improve the implementation of evidence-based healthcare in prisons: a scoping review. HEALTH & JUSTICE 2023; 11:1. [PMID: 36595141 PMCID: PMC9809036 DOI: 10.1186/s40352-022-00200-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/13/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are challenges to delivering high quality primary care within prison settings and well-recognised gaps between evidence and practice. There is a growing body of literature evaluating interventions to implement evidence-based practice in the general population, yet the extent and rigour of such evaluations in incarcerated populations are unknown. We therefore conducted a scoping literature review to identify and describe evaluations of implementation interventions in the prison setting. METHODS We searched EMBASE, MEDLINE, CINAHL Plus, Scopus, and grey literature up to August 2021, supplemented by hand searching. Search terms included prisons, evidence-based practice, and implementation science with relevant synonyms. Two reviewers independently selected studies for inclusion. Data extraction included study populations, study design, outcomes, and author conclusions. We took a narrative approach to data synthesis. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for scoping reviews. RESULTS Fifteen studies reported in 17 papers comprised one randomised controlled trial, one controlled interrupted time series analysis and 13 uncontrolled before and after studies. Eight studies took place in the US and four in the UK. Ten studies evaluated combined (multifaceted) interventions, typically including education for staff or patients. Interventions most commonly targeted communicable diseases, mental health and screening uptake. Thirteen studies reported adherence to processes of care, mainly testing, prescribing and referrals. Fourteen studies concluded that interventions had positive impacts. CONCLUSIONS There is a paucity of high-quality evidence to inform strategies to implement evidence-based health care in prisons, and an over-reliance on weak evaluation designs which may over-estimate effectiveness. Whilst most evaluations have focused on recognised priorities for the incarcerated population, relatively little attention has been paid to long-term conditions core to primary care delivery. Initiatives to close the gaps between evidence and practice in prison primary care need a stronger evidence base.
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Affiliation(s)
- Jenna Blackaby
- Leeds Institute of Health Science, University of Leeds, Leeds, UK.
| | - Jordan Byrne
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Sue Bellass
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | | | - Robbie Foy
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
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Papaluca T, Craigie A, McDonald L, Edwards A, MacIsaac M, Holmes JA, Jarman M, Lee T, Huang H, Chan A, Lai M, Sundararajan V, Doyle JS, Hellard M, Stoove M, Howell J, Desmond P, Iser D, Thompson AJ. Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C. PLoS One 2020; 15:e0242101. [PMID: 33206696 PMCID: PMC7673506 DOI: 10.1371/journal.pone.0242101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background and aims Prison-based HCV treatment rates remain low due to multiple barriers, including accessing transient elastography for cirrhosis determination. The AST-to-platelet ratio index (APRI) and FIB-4 scores have excellent negative predictive value (NPV) in hospital cohorts to exclude cirrhosis. We investigated their performance in a large cohort of prisoners with HCV infection. Methods This was a retrospective cohort study of participants assessed by a prison-based hepatitis program. The sensitivity, specificity, NPV and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis were then analysed, with transient elastography as the reference standard. The utility of age thresholds as a trigger for transient elastography was also explored. Results Data from 1007 prisoners were included. The median age was 41, 89% were male, and 12% had cirrhosis. An APRI cut-off of 1.0 and FIB-4 cut-off of 1.45 had NPVs for cirrhosis of 96.1% and 96.6%, respectively, and if used to triage prisoners for transient elastography, could reduce the need for this investigation by 71%. The PPVs of APRI and FIB-4 for cirrhosis at these cut-offs were low. Age ≤35 years alone had a NPV for cirrhosis of 96.5%. In those >35 years, the APRI cut-off of 1.0 alone had a high NPV >95%. Conclusion APRI and FIB-4 scores can reliably exclude cirrhosis in prisoners and reduce requirement for transient elastography. This finding will simplify the cascade of care for prisoners living with hepatitis C.
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Affiliation(s)
- Timothy Papaluca
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Anne Craigie
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Lucy McDonald
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Amy Edwards
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Michael MacIsaac
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Jacinta A. Holmes
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Matthew Jarman
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Tanya Lee
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Hannah Huang
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Andrew Chan
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Mark Lai
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jessica Howell
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Paul Desmond
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - David Iser
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
- * E-mail:
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Connoley D, Francis-Graham S, Storer M, Ekeke N, Smith C, Macdonald D, Rosenberg W. Detection, stratification and treatment of hepatitis C-positive prisoners in the United Kingdom prison estate: Development of a pathway of care to facilitate the elimination of hepatitis C in a London prison. J Viral Hepat 2020; 27:987-995. [PMID: 32449969 DOI: 10.1111/jvh.13336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/29/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
The United Kingdom is committed to eliminating hepatitis C virus (HCV) infection by 2025. The prison estate provides an opportunity to identify and treat HCV-positive individuals in a high-prevalence environment. We designed and implemented a pathway of care within a London prison to diagnose, stratify and link HCV-positive prisoners into care. This study was a two-phase case study of a HCV care pathway. New arrivals to the prison were offered blood-borne virus screening with dried blood spot testing at their secondary health check. Those with active infection completed disease stratification tests and were reviewed at a weekly hospital-based multidisciplinary team meeting to determine management. In Phase-2, the pathway was redesigned to improve testing and the referral of HCV-positive prisoners into treatment. Over the 30-month evaluation period, 12,946 people were received in the prison. During Phase-1, 19.6% of new arrivals completed blood-borne virus testing, with 7.3% identified as HCV-positive. Just 8.3% of HCV-positive individuals were treated or referred for treatment in Phase-1. During Phase-2, 30% of new receptions completed BBV testing and 3.9% were identified as HCV-positive. Linkage into care was improved, with 38.9% treated or referred during the second phase. Poor access to testing and referral to treatment limit the effectiveness of care provision for prisoners with HCV. Elimination of HCV in prisons requires local service configuration to ensure high uptake of testing, with all HCV-positive cases then offered treatment during custody or referral on to treatment after release.
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Affiliation(s)
- Declan Connoley
- Monash University, Clayton, Vic., Australia.,Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,Monash Health Australia, Clayton, Vic., Australia
| | - Seth Francis-Graham
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | | | - Nnenna Ekeke
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Claire Smith
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Douglas Macdonald
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - William Rosenberg
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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Morey S, Hamoodi A, Jones D, Young T, Thompson C, Dhuny J, Buchanan E, Miller C, Hewett M, Valappil M, Hunter E, McPherson S. Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine. J Viral Hepat 2019; 26:101-108. [PMID: 30315691 DOI: 10.1111/jvh.13017] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022]
Abstract
With recent advances in antiviral therapy, there is an opportunity to eliminate hepatitis C virus (HCV) from the UK population. HCV is common in incarcerated individuals, with previous estimates suggesting ~7% of the UK prison population is anti-HCV antibody positive. Increasing diagnosis and treatment of HCV in prison is a priority in seeking to eliminate transmission in the general population. Thus the study aimed to assess the impact implementation of: (a) A universal offer of blood borne virus testing (UOBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; (b) Telemedicine clinics (TC) within North East England (NEE) prisons to increase HCV treatment rates. UOBBVT was initially implemented at Her Majesty's Prison (HMP) Durham, commencing March 2016. From March 2016 to February 2017, 2831 of 4280 (66%) new receptions were offered blood borne virus (BBV) testing. Of these, 1495 (53% of offered) accepted BBV testing, of whom 95 (6.4%) were HCV antibody positive, with 47 of those 95 (49.5%) HCV RNA positive, suggesting a prevalence of active infection in the tested population of 3.1% (95% CI 2.4%-4.2%). Between August 2015 and October 2017, 80 individuals were seen in the TC and 57 (71%) commenced antiviral therapy. Of those with known outcome (n = 29), 100% achieved sustained virological response. In the year prior to implementation, only four patients received HCV treatment. In conclusion, a universal offer of BBV testing to inmates presenting at HMP reception coupled with linkage into specialist care via TC can substantially increase rates of testing, diagnosis and treatment of HCV in this high-prevalence population.
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Affiliation(s)
- Sarah Morey
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Northumbria University, Newcastle upon Tyne, UK
| | - Abi Hamoodi
- Public Health England, Newcastle upon Tyne, UK
| | | | - Tina Young
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Julie Dhuny
- NHS England (Cumbria and the North East), Darlington, UK
| | - Emma Buchanan
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Carolyn Miller
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Margaret Hewett
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Manoj Valappil
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ewan Hunter
- Department of Infection and Tropical Medicine, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Stuart McPherson
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Martin NK, Vickerman P, Brew IF, Williamson J, Miners A, Irving WL, Saksena S, Hutchinson SJ, Mandal S, O’Moore E, Hickman M. Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis. Hepatology 2016; 63:1796-808. [PMID: 26864802 PMCID: PMC4920048 DOI: 10.1002/hep.28497] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/08/2016] [Indexed: 12/31/2022]
Abstract
UNLABELLED Prisoners have a high prevalence of hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity of care. We assessed the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons compared to status quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8-24 weeks) or interferon (IFN)-free direct-acting antivirals (DAAs; 8-12 weeks, 95% sustained virological response, £3300/week). Costs (British pounds, £) and health utilities (quality-adjusted life years) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assumed 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/ex-PWID treated within 2 months of diagnosis in prison. PWID and ex-PWID or non-PWID are in prison an average 4 and 8 months, respectively. Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/quality-adjusted life years gained compared to current testing/treatment and is 45% likely to be cost-effective under a £20,000 willingness-to-pay threshold. Switching to 8-week to 12-week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/quality-adjusted life years gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or with 8 weeks' duration. CONCLUSIONS Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status quo voluntary risk-based testing under a £20,000 willingness to pay with current treatments but likely to be cost-effective if short-course IFN-free DAAs are used and could be highly cost-effective if PWID treatment rates were increased. (Hepatology 2016;63:1796-1808).
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Affiliation(s)
- Natasha K Martin
- Division of Global Public Health, University of California San Diego, USA
- School of Social and Community Medicine, University of Bristol, UK
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, UK
| | | | | | - Alec Miners
- London School of Hygiene and Tropical Medicine, UK
| | | | | | | | | | | | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
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