Access to HEP care in Prisons
A micro-elimination project to improve screening and linkage to care for people with viral hepatitis C (HCV) in prison settings in Greece, has been run since 2019 by the Hellenic Liver Patients’ Association (Prometheus) in collaboration with the Greek Association for the Study of the Liver, with data management support from the University of Athens.
The prevalence of HCV is higher amongst prisoners than in the general population, yet they are rarely screened for the disease. This negatively impacts the patients’ health and risks further spreading of the virus. In Greece, around 10,000 people are imprisoned in 36 centres. Projects aimed at improving screening and linkage to care in prison settings are essential to driving HCV elimination forward.
The administration in large detention centers, as well as in prisons in which the population frequently changes as they act more as ‘transit’ centres, tend to be less co-operative. This is due to the extra workload that the organisation of HCV screening entails for the staff. Also, many inmates fear stigma and discrimination – for example, they are concerned about non-eligibility for certain jobs if they test positively. Finally, undocumented migrants were initially denied access to health coverage.
Over the past three years, 50% of the prison population of Greece has been screened for HCV and received information and support on how to avoid transmission. Out of the 5,000 prisoners, almost 700 have been diagnosed with the virus and linked to care. The success of the project is partly attributable to the incentivisation of screening, which saw the participation rate rise from 35% initially to 85-90%. Around 300 of those diagnosed with the virus in prison (more than 40%) were undocumented migrants. Their treatment should be covered as soon as the amendment to the law has been passed.
Prometheus started its HCV micro-elimination project in the small- and medium-sized prisons in Greece, where the administration proved to be more cooperative. To overcome inmates’ disinterest in HCV, as well as their fear of stigma and discrimination, Prometheus has guaranteed confidentiality and non-disclosure of the results for all participants in screening. Furthermore, small incentives in the form of EUR 10 credit vouchers for phone or Skype calls are given to those who agree to a test.
Difficulties arise when prisoners are transferred to other prisons before the test results could be communicated. This highlights the need to improve record keeping and traceability of patients during their time in prison. Prometheus has also successfully advocated for a legal amendment in Parliament to ensure health coverage for undocumented migrants in a prison setting.