Grant: Project Grant

The prevalence of chronic hepatitis C virus (HCV) infection is approximately 40-fold higher among provincial prison inmates compared to the Canadian population. Left untreated, there is ongoing risk of transmission within prisons and to the community at large upon release. Treatment of prisoners for HCV could substantially reduce prevalent and incident infections. However, due to short sentences in provincial prisons, inmates are often released prior to treatment completion, making linkage to HCV care upon release essential. Currently, less than 1% of inmates link to care following release. Patient navigation, whereby a peer typically assists patients in completing a health care goal, may have a role in linking inmates to HCV care following release. However, no research has yet to be done on different models of patient navigation for inmates. While linkage to care is the rate-limiting step in the HCV cascade of care for released inmates, linkage in the absence of treatment uptake will fail to achieve the goal of HCV micro-elimination, underscoring treatment uptake as the most meaningful clinical outcome. This study will assess two models of patient navigation, a transitional and a tailored model, on HCV treatment uptake. The tailored model will be designed following one-to-one qualitative interviews with inmates and an expert review of providers and inmates. Both models will be implemented and evaluated on treatment uptake, the primary outcome measure, as well as linkage to care, the secondary outcome measure. The goal will be to capitalize on the existing infrastructure and partnerships that are currently in place at Bordeaux prison to conduct this study. The findings of this study will be critical in developing optimal models of patient navigation for scale up in other provincial prisons, ensuring that we are one step closer towards to the "micro-elimination" of HCV among one of the most important sub-populations fueling the current epidemic in Canada.