Unlocking Access to HCV Testing in Jail: Stakeholder Involvement in Research Is the Missing Key

项目概要/摘要 美国约有300万人患有丙型肝炎病毒感染（HCV）， HCV的负担高度集中在监禁人群中。治疗HCV的方法是 可用，但在更正设置中很少可用。在获得保健服务方面存在差距， 社区中白色和非白色人群之间的HCV护理，非白色人群 更高的监禁率。因此，肝病是导致死亡的主要原因之一， 囚犯，尤其是非白人囚犯。 一种克服监禁中HCV护理健康差异的可行方法 越来越多的人被诊断为HCV。这一做法对于那些 与HCV治疗相关的被监禁人群--被监禁不到2.5年的人 释放后安排。选择退出传染病检测既增加了总体频率， 测试和减少测试中的种族差异。与选择性测试不同， 同意进行测试，选择退出测试通知个人，他们将接受测试，除非 他们拒绝了。联邦政策建议在监狱中选择退出HCV检测， 在所有马萨诸塞州（MA）监狱通过法院裁决授权。选择退出测试不是 在MA监狱中执行。 我的研究提案的总体目标是改善监狱中HCV检测的可及性 最终目的是降低美国HCV的流行率。本研究的第一个目的 一项建议是通过回顾性研究，将目前的HCV检测实践与检测政策进行比较， 图表审查，重点是在获得检测方面的种族差异。第二个目标是混合动力 有效性-实施目标，目标是实施选择退出HCV检测， 评估选择退出测试的有效性，以增加测试频率并减少种族歧视 HCV检测的差异。在研究活动中嵌入的是一个强大的培训计划，包括 先进的流行病学和实施科学方法。关键利益攸关方的支持 包括来自刑事司法系统、医疗保健系统、 监狱里的医疗服务提供者，以及MA公共卫生部门。通过创新培训得到加强 和协同方法学科，完成这项研究建议将是 致力于使用实施科学的成功研究生涯的基础 改进惩教机构提供的医疗保健质量和公平性的方法。

Project Summary/Abstract About 3 million people in the US are living with hepatitis C virus infection (HCV), and the burden of HCV is highly concentrated in incarcerated populations. Curative HCV treatment is available, but infrequently available in corrections settings. There are disparities in access to HCV care between White and Non-White people in the community, and non-White people have higher rates of incarceration. As a result, liver disease is one of the leading causes of death in inmates, especially Non-White inmates. One feasible approach to overcoming health disparities for HCV care in incarcerated populations is increasing the diagnosis of HCV. This approach is particularly pragmatic for the jailed population—people incarcerated for less than 2.5 years—with linkage to HCV treatment arranged post-release. Opt-out infectious disease testing both increases overall frequency of testing and decreases racial disparities in testing. Unlike opt-in testing, which requires explicit agreement to perform testing, opt-out testing informs individuals that they will be tested unless they decline. Opt-out HCV testing in prisons is recommended by federal policy, and recently mandated in all Massachusetts (MA) prisons through a court ruling. Opt-out testing is not mandated in MA jails. The overarching goal of my research proposal is improving access to HCV testing in jails with the ultimate aim of reducing the prevalence of HCV in the US. The first aim of this research proposal is a comparison of current HCV testing practices to testing policy through retrospective chart review with a focus on racial disparities in access to testing. The second aim is a hybrid effectiveness-implementation aim with the goal of implementing opt-out HCV testing and evaluating effectiveness of opt-out testing to increase testing frequency and decrease racial disparities in HCV testing. Imbedded in the research activities is a robust training plan including advanced epidemiology and implementation science methodology. Support of key stakeholders has been confirmed, including representatives from the criminal justice system, health care providers in the jail, and the MA public health department. Augmented by training in innovative and synergistic methodologic disciplines, completion of this research proposal will be the foundation for a successful research career devoted to using implementation science methodology to improve the quality and equity of health care provided in corrections settings.