Investing in Community Care Is an Important Goal and Need for Eliminating Hepatitis C in the United States: An Abolitionist Perspective.

Recent nationwide racial justice uprisings following ongoing police violence against Black communities juxtaposed with the COVID-19 pandemic have increased the urgency for a reckoning around the ineffectiveness and harm caused by the carceral apparatus. It is well documented that the correctional system was founded upon and continues the legacy of slavery and white supremacy. Research has shown that incarceration directly contributes to many negative health outcomes, including increased risk and spread of hepatitis C virus (HCV) infections, especially among people who inject drugs. This high burden of HCV disproportionately impacts low-income communities of color, who not only report higher rates of substance use due to pervasive discrimination but are also over-incarcerated as a result of structural racism and the War on Drugs. The COVID-19 pandemic further underscores that correctional facilities are fundamentally structured to promote health inequities. Minoritized communities who are overrepresented in corrections continue to be put at increased risk of COVID-19 in overcrowded facilities, are isolated from social support and medical care, and have been ignored in vaccination strategies. In this perspective, we argue that HCV interventions within the carceral apparatus will remain largely ineffective due to the negative health impacts of incarceration. Instead, we propose adopting abolitionist principles for HCV elimination-divesting from the carceral apparatus to prioritize community-based efforts on promoting HCV screening, treatment, and prevention. In doing so, the nation will have not only the capacity to meaningfully eliminate HCV but also the potential to improve overall societal outcomes.

Lessons learned from keeping NSW's prisons COVID-free.

PURPOSE: New South Wales (NSW) correctional system houses 30% of prisoners in Australia and at this time has only had a single documented case of COVID-19 amongst its prisoner population. The coordinated response by Justice Health and Forensic Mental Health Network (The Network) undertaken with the support of NSW Ministry of Health, in partnership with Corrective Services NSW (CSNSW), Youth Justice and private jails has ensured that the NSW correctional system has remained otherwise COVID-free. DESIGN/METHODOLOGY/APPROACH: A research study of how a range of partners which support the operations of NSW Correctional System developed an effective approach for the prevention a COVID-19 epidemic amongst its inmates. FINDINGS: Establishment of effective partnerships, early coordination of representatives from all aspects of the NSW correctional system, limited access to the correctional environment, reduced prison population and strict isolation of all new receptions have all contributed to maintaining this COVID-free status despite other NSW settings with similar risk profiles, such as aged care facilities and cruise ship arrivals, experiencing serious outbreaks. RESEARCH LIMITATIONS/IMPLICATIONS: Although Australia/New Zealand context of suppressed community infection rates for COVID-19 (which are approaching elimination in some jurisdictions) is in contrast to the situation in other parts of the world, the principles described in this paper will be useful to most other correctional systems. PRACTICAL IMPLICATIONS: Modelling was used to underline our approach and reinforced the veracity of following this approach. ORIGINALITY/VALUE: The Network and CSNSW has been able to mount an effective, integrated response to the COVID-19 pandemic, which has been sustainable through the first peak of COVID-19 cases. This case study catalogues the process of developing this response and details each intervention implemented with inventive use of tables to demonstrate the impact of the range of interventions used.

"Prison life is very hard and it's made harder if you're isolated": COVID-19 risk mitigation strategies and the mental health of incarcerated women in California.

PURPOSE: This study aims to describe the COVID-19 risk mitigation strategies implemented in California prisons and the impact of these policies on the mental health of incarcerated women. DESIGN/METHODOLOGY/APPROACH: The authors conducted semi-structured qualitative interviews with ten women who were over the age of 50 and/or had a chronic illness and had been incarcerated in California prisons during the COVID-19 pandemic. The authors also interviewed ten health-care providers working in California jails or prisons during the pandemic. Interviews were analyzed using a grounded theory coding framework and triangulated with fieldnotes from ethnographic observations of medical and legal advocacy efforts during the pandemic. FINDINGS: Participants described being locked in their cells for 23 hours per day or more, often for days, weeks or even months at a time in an effort to reduce the spread of COVID-19. For many participants, these lockdowns and the resulting isolation from loved ones both inside and outside of the prison were detrimental to both their physical and mental health. Participants reported that access to mental health care for those in the general population was limited prior to the pandemic, and that COVID-19 risk mitigation strategies, including the cessation of group programs and shift to cell-front mental health services, created further barriers. ORIGINALITY/VALUE: There has been little qualitative research on the mental health effects of the COVID-19 pandemic on incarcerated populations. This paper provides insight into the mental health effects of both the COVID-19 pandemic and COVID-19 risk mitigation strategies for the structurally vulnerable older women incarcerated in California prisons.

Micro-eliminating hepatitis C in a network of 47 English Prisons through an industry, prison healthcare and patient organisation partnership

Background and aims: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) in England by 2025, five years earlier than World Health Organisation goals. With a reported HCV prevalence of ∼6% in male prisons, and ∼12% in female prisons, secure environments are an essential component of this elimination plan. In 2020, NHSE defined HCV micro-elimination as ³95% of prison residents tested within the previous 12 months, ³90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Method: To support NHSE in their HCV Elimination Program, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT)was formed in 2019. PPG is the provider of healthcare to 47 English prisons with approximately 30, 000 residents. PPG Regional BBV Lead Nurses, and Gilead Medical Scientists worked with prison and HCV stakeholders to optimise test and treat pathways for new prison admissions. Whole prison HCV Intensive Test and Treat events (HITTs) were also run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Results: Following pathway optimisation across the PPG network of 47 prisons, the HCV screening within 7 days of prison entry increased from 41% in May 2019 to 84% in October 2021. This increase was achieved despite there being significant restrictions to reduce the transmission of COVID-19 being in place across all English prisons. HITTs have been performed in 15 PPG prisons to-date. 1, 909 new RNA+ diagnoses were made during this time with 1, 848 patients started on direct-acting antiviral treatments. By November 2021, 16 out of the 47 prisons have been given micro-elimination status by NHSE with 4 more having submitted data demonstrating achievement of this target and awaiting decision. A further 4 more prisons are on track to achieve micro-elimination by April 2022. Conclusion: This partnership has demonstrated that, even during a global pandemic, it is possible to achieve the micro-elimination of HCV in a defined setting. Maintenance of micro-elimination status is essential if we are to achieve the WHO HCV targets, requiring robust pathways that are regularly adapted to the changing environment, and systems for tracking performance, both of which have been put in place by this partnership.

DEFERRAL OF ROUTINE CARE IN THE CALIFORNIA STATE PRISON POPULATION DURING THE COVID-19 PANDEMIC

BACKGROUND: The COVID-19 pandemic has diverted health care resources from the management of chronic diseases toward acute care, with potential long-term consequences, especially among vulnerable populations. Incarcerated populations bear a higher chronic disease burden than the general community, while simultaneously experiencing COVID-19 outbreaks of higher acuity and associated mortality. The extent to which COVID-19 disrupted routine medical care within prison health systems has not been fully characterized. METHODS: We analyzed data from the California Department of Corrections and Rehabilitation (CDCR) for each California state prison (N=35) by month describing the delivery of medical care from January 1, 2019, to July 31, 2021. These data included quality measures describing the timeliness of clinical services for preventive care and chronic disease management, grouped by the CDCR into three categories (diagnostic, general medical, and specialty care). Statewide mean rates for each measure were weighted by prison population. Comparing these measures with prison-level COVID-19 incidence data from the CDCR for this period, we conducted a descriptive analysis of trends in the timely delivery of medical care in the CDCR during the COVID-19 pandemic relative to a pre-pandemic baseline period (2019). RESULTS: Populations housed within CDCR facilities experienced an initial wave of COVID-19 cases between June and October 2020, followed by a larger wave between November 2020 and February 2021. During the second wave, timely delivery of non-urgent PCP services decreased from a baseline of 91.7% to 79.0% (mean difference -12.7%;95% [CI], -16.6 to -8.9). Timely delivery of non-urgent specialty services decreased from a baseline of 87.3% to 56.4% (mean difference -31.0%;95% [CI], -36.8 to -25.1). Smaller, but statistically significant declines were seen in the timeliness of urgent PCP services (mean difference -7.8%;95% [CI], -10.2 to -5.5) and high priority specialty services (mean difference -13.8%;95% [CI], -17.1 to -10.4). CONCLUSIONS: The population incarcerated in California state prisons experienced sustained, significant delays in receipt of routine care during the COVID-19 pandemic. In comparison, outpatient visit volume in nonincarcerated populations nationwide decreased by up to 58% during the initial wave, but volumes recovered rapidly with a shift toward virtual care and remained stable despite the second wave. Policies to bolster prison health care systems during the ongoing pandemic will be critical for a stable recovery in access to chronic disease management and preventive care for this vulnerable population.

Locking out the virus: management of a SARS-CoV-2 outbreak in an Italian prison.

PURPOSE: In this paper, the authors present insights and findings drawn from the authors' experiences of containing a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large prison in northern Italy.Within penitentiaries, close-quarter living is ripe terrain for outbreaks of disease among detainees and staff. If left unchecked, these outbreaks can easily spill over the prison walls to threaten the general public. Moreover, these risks are heightened by preexisting environmental conditions, especially overcrowding. It is thus paramount to establish effective protocols for prevention, early detection and outbreak management. The purpose of this article is to document a strategy that been at least partially successful in reducing the damage that could potentially be caused by a sustained SARS-CoV-2 outbreak within a correctional facility. DESIGN/METHODOLOGY/APPROACH: The authors conducted a retrospective analysis on patients' and health-care workers' medical records to obtain demographic and clinical information. Descriptive data analysis was then carried out. FINDINGS: In total, the authors tested 453 people with oropharyngeal swabs from March 15, 2020, to June 30, 2020. Of these people, 58 were positive and 395 were negative, with a prevalence of 12.8%.Of the 453 patients, 60 were health workers: 24 tested positive for SARS-CoV2 ribonucleic acid (RNA); 18 developed symptoms; and three needed hospitalization.Among patients in detention, 34 resulted positive for SARS-CoV-2 RNA. Two were hospitalized and later died. Both had severe preexisting conditions; they were aged 76 and 59 years old, respectively. ORIGINALITY/VALUE: In this study, the authors describe the design and effective implementation of prevention and containment measures against SARS-CoV-2 within the walls of a correctional facility. The authors describe how they rapidly created clean confinement sections to isolate cases in an environment designed for security at the expense of virus containment and how educational efforts have played a vital role in their strategy.

COVID-19 and incarcerated older adults: a commentary on risk, care and early release in Australia.

PURPOSE: The purpose of this commentary is to draw upon available literature and practices related to COVID-19 and management of older incarcerated adults in Australia to highlight key matters for better risk management and care of this population during this and future infectious disease pan/epidemics. DESIGN/METHODOLOGY/APPROACH: The present commentary draws on current policies, practices and literature regarding the health, needs and management of older incarcerated adults in Australia to discuss risk, care and early release for this population during the COVID-19 pandemic. FINDINGS: Incarcerated persons experience poorer health and accelerated age-related decline compared to those in the general community. The present situation offers the opportunity to fill knowledge and practice gaps, including policies for staff training, identification of dementia and cognitive decline, assessment of mobility issues, addressing barriers to health-seeking, possibilities of medical or compassionate release, risk assessment and release protocols and post-release needs. PRACTICAL IMPLICATIONS: While Australian prisons have acknowledged the vulnerability of older persons, more focused adaptation of COVID-19-related policies to consider adults as young as 45 years are needed. Appropriate ethical identification and management of cases in this population is needed, as is discussion on issues of decarceration and medical release. Re-conceptualisation of incarcerated adults as "citizens in need of care", rather than as "offenders to be secured", will be beneficial. Robust, local evidence is needed to assist decision-making. ORIGINALITY/VALUE: This is a comprehensive, focused review of relevant evidence, policies and practices for a growing subpopulation of prisoners worldwide with complex needs and particular vulnerability to the COVID-19.

The evolution of health care in the Texas correctional system and the impact of COVID-19.

Health care under the jurisdiction of the Texas Department of Criminal Justice has evolved over time to provide prisoners greater access to medical care, including psychiatric care and substance abuse assistance. Mental illness and chronic conditions, such as hypertension, chronic obstructive pulmonary disease, diabetes, and heart disease, are common in prisoners in Texas and across the nation and increase the cost of health care. The average annual health care cost per prisoner in Texas was $4077 in 2015. Although the Texas prison system has undergone changes, such as the use of telemedicine and protocols for preventive measures, to address the varying medical needs of prisoners in correctional facilities, there is still considerable criticism regarding prison policies and incomplete access to medical care. In addition, the ongoing COVID-19 pandemic has added significant stress to correctional health care in Texas and highlights the importance of organized health care for prisoners. This report reviews the history and evolution of health care delivery in Texas's correctional facilities, outlines ongoing efforts to improve medical care in prison facilities, and describes current policies to limit COVID-19 infections in Texas prisons.