CTNPT 034: HCV Screening in Prison Inmates

About The Study

This pilot study is comparing the acceptability of two hepatitis C virus (HCV) screening tests among short-term provincial prison inmates. Specifically, the study is comparing the proportion of study participants who, when offered, agree to testing via fingerprick versus venipuncture (blood draw).

About The Disease

Approximately 250,000 Canadians are currently living with HCV. The primary cause of HCV infection is injection drug use — some estimates suggest that up two-thirds of injection drug users have been exposed to HCV. Many Canadian inmates report injection drug use and one in four have been exposed to HCV before or during their time in a correctional facility. In contrast, less than 1 per cent of the general Canadian population has been exposed to HCV; this means that the prison population is 40 times more likely to be exposed to HCV compared to the general population.

Despite these high rates, HCV screening rates in prisons are currently estimated at one per cent, partly because testing must be voluntarily requested. As a result, inmates are not tested systematically when they enter prison or based on their risk factors, such as injection drug use, unsafe tattooing, or body piercing practices. The current HCV testing standard in prisons is using venipuncture (blood draw). However, this method requires a follow-up visit to receive results meaning that short-term inmates may be released or transferred before their results are available.

An alternative HCV test is available via fingerprick. This test, though more expensive than venipuncture, gives results in 20 minutes, meaning it doesn’t require a second visit. The acceptability of HCV screening via fingerprick testing has been assessed in people who inject drugs but never in the prison population.

Study Approach

CTNPT 034 will recruit a minimum of 75 inmates with sentences between 2 and 12 weeks; inmates will be approached within 24 hours of arrival to prison. Inmates who consent to participate in the study will complete a baseline questionnaire about injection drug use and HCV. Participants will then be asked if they would like to be screened for HCV and, if they consent, will be randomized to receive either venipuncture or fingerprick testing. Those who refuse screening will complete a questionnaire about their perceptions of testing. Participants who undergo screening will complete a questionnaire before and after to assess their perceptions and experiences with testing.

Acceptability will be measured by the proportion of participants who agree to be tested when offered one of the screening methods. The research team will also compare the proportion of inmates screened via venipuncture versus fingerprick who receive their test results before their prison release.