Factors influencing the acceptability of hepatitis C screening among people with experience of incarceration in Quebec, Canada: A qualitative descriptive study guided by the Theoretical Domains Framework

Abstract

Background: For hepatitis C virus (HCV) elimination to occur in carceral settings, opt-out screening on admission, the first step in the HCV care cascade, is recommended. As screening strategies in Quebec provincial prisons vary, we aimed to identify factors influencing the acceptability of HCV screening among people with experience of incarceration (PWEI).

Methods: A theory-based qualitative descriptive study was used to conduct semi-structured interviews. Interview guides and analyses were guided by the Theoretical Domains Framework (TDF). Directed content analysis was used to identify domains within the TDF reflecting barriers and facilitators to HCV screening.

Results: Nineteen interviews were conducted from January-December 2022. Most (58 %) participants identified as cisgender men, and the median age was 48 years. Social influences was the most frequently coded domain indicating the importance of peer networks in influencing HCV screening uptake. This was followed by Environmental context and resources, underscoring the prison environment's role as both a barrier and facilitator to HCV screening, and Beliefs about consequences, pointing to perceived outcomes of a positive test, underpinned by a lack of knowledge, stigma, and fear/anxiety, on HCV screening uptake.

Conclusions: The TDF was useful in identifying factors associated with the acceptability of HCV screening among PWEI. Future interventions should seek to leverage peer networks, integrate point-of-care HCV testing, and provide whole-of-sector education and wrap-around services to better support PWEI and contribute to broader efforts to eliminate HCV among incarcerated populations.

Keywords: Hepatitis C virus; Implementation science; Screening, prison, people in prison; Theoretical domains framework.