Introduction Hepatitis C (HCV) testing and treatment in English prisons remains low,¹with the reasons being poorly understood. Prison Custody Officers (PCOs) are in continuous contact with prisoners and able to observe factors that may influence prisoners’ choice in accepting HCV testing and treatment. However, PCO’s views are not represented in the UK literature. A qualitative enquiry was thus undertaken entitled: Unlocking Views: what do Custody Officers thInk about hepatitis Ctesting and treatment of prisonErs? (VOICE).

Method Semi-structured interviews were conducted with 10 PCOs employed at a male category B prison. The prison is one of a limited number that can provide anti-viral treatment and ‘medical hold’ for HCV infected inmates. The interviews were audio-recorded and transcribed at the prison.

Results Four key themes emerged: Safeguarding; Stigma; Confidentialityand Education. All participants asserted that if a prisoner poses a threat to the overall security of a prison the ‘medical hold’ will be overridden, irrespective of the cost of the medical treatment the prisoner is receiving or any negative health consequences which may arise, with the exception of anything immediately life-threatening. All of the PCOs supported an opt-out HCV testing strategy with some questioning the rationale for this not being mandatory, and felt that prison was a good opportunity to access HCV treatment. Several PCOs explained that prisoners may be excluded from their social groups if their attendance at a hepatitis testing or treating appointment is observed or deduced, so the ‘prison code’ of social interaction and behaviour amongst prisoners might represent a barrier to testing and treatment. The PCOs respected prisoners’ confidentiality regarding health issues, but this could be compromised during violent incidents if they perceived their colleagues to be at risk of contracting a blood borne virus through spitting or biting. All of the PCOs displayed limited knowledge about HCV risk factors, transmission, treatment and consequences of untreated infection, yet this staff group have the most contact with prisoners.

Conclusion Models of health care delivery that facilitate prisoners moving to other prisons without a break in treatment continuity may be more likely to result in prisoners commencing and completing anti-viral therapy. Further barriers may lie in the unseen realm of social behaviour dictated by the ‘prison code’. PCOs require further training about HCV and an education package could increase the testing and treatment uptake.

Disclosure of interest None Declared.

Reference

1. Public Health England (2014) Hepatitis C in the UK: 2014 report [online]. Available at: https://www.gov.uk/government/publications/hepatitis-c-in-the-uk[Accessed 23 February 2015]