Work

299. “Where the Rubber Meets the Road”: Stakeholders’ Perspectives about the Current State of HCV Care Delivery in Massachusetts Jails

Year: 2019

Type: article

Abstract: Background HCV is highly prevalent in criminal-justice involved populations (CJIP). Nationally, the operationalization of guideline-driven HCV care (including testing and treatment) for CJIP has been challenging, prompting this study to understand barriers and facilitators. Methods We used purposeful sampling strategies to recruit key stakeholders including people who are incarcerated, clinicians providing care in jail, clinicians providing care outside of jail, corrections administrators, and representatives of industry, public health and public policy. Semi-structured interviews were performed in Spanish or English, based on preference of participant. Written notes were used to capture details from interviews in jails and interviews outside of jail were recorded. People interviewed outside of jail were offered a stipend. Interviews were coded and analyzed with a compare and consensus approach. Results Of 120 people, 49 (41%) people agreed to be interviewed in each of the stakeholder categories including 21 men who were incarcerated (mean age 32 [IQR 25, 39], 60% non-White). Barriers to HCV care delivery included (1) Fragmented healthcare delivery because of transient nature of CJIP (2) Frustration and disempowerment experienced by people incarcerated in jail and (3) Heterogeneous views on stakeholders responsible for providing and financing HCV care in jails. Facilitators to HCV care delivery included (1) Incarcerated population’s interested in HCV care for public and personal health and (2) An existing strong public health infrastructure in place supporting HIV care delivery. Conclusion Understanding various stakeholders’ views of barriers to HCV care in jails is a necessary first step to building improved care pathways. Mutual recognition may help to focus limited administrative and fiscal resources on HCV care for this transient population. Disclosures All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofz360.374