{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T23:20:07Z","timestamp":1764890407860,"version":"3.46.0"},"reference-count":24,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","award":["ISR-GB-18-10541."],"award-info":[{"award-number":["ISR-GB-18-10541."]}],"id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,3]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Testing rates for hepatitis C virus (HCV) of new prison entrants vary considerably between prisons, with particularly low rates in category B male remand prisons. Improvement in testing rates will require an understanding of the underlying reasons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the rates and uptake of testing for HCV in new entrants to three category B prisons in England and to use an implementation science framework to analyse the facilitators and barriers to meeting national standards for HCV testing in a prison healthcare environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This mixed-methods non-interventional study collated three data sets: anti-HCV testing uptake in prisons, plus data on the prior location of each individual (transfer from another prison or community) and their length of stay; a questionnaire designed to identify reasons for decline of a test administered to people in prison (PIP) who refused testing; qualitative interviews with key stakeholders in the process of prison HCV testing, with analysis based on the Consolidated Framework for Implementation Research (CFIR) to enable identification of barriers and facilitators to testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted in the East Midlands region of England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Data were obtained from three category B male remand prisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Primary outcome measures: This descriptive study sought to understand factors that influence anti-HCV test uptake in three English remand prisons. The selected prisons serve a combined population of 2.3\u2009million and have the capacity to accommodate a total of 2030 prisoners. The testing rates within 4 weeks of arrival in the three prisons over a 12-month study period (March 2022\u2013March 2023) were 17.2%, 28.3% and 42.5%. PIP were more likely to be tested if they arrived from the community compared with interprison transfer (39.13% vs 29.5%). Testing uptake rates increased with length of prison stay (12.4%, 33.6% and 40.7% for stays of 0\u20137, 15\u201321 and &gt;28\u2009days, respectively). The most common reasons for not accepting a test were a lack of interest and not wanting to be retested. 13 semistructured interviews revealed 21 barriers and 9 facilitators to testing, summarised in 5 overarching themes: misunderstanding of the concept of opt-out testing; nurses not meeting performance targets due to competing priorities; prison regime hampering healthcare delivery; absence of a specifically appointed co-ordinator who is held to account; incentivising nurses to test and PIP to accept testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The rates of testing for HCV in three category B male remand prisons were far below national standards. Key recommendations to improve testing rates, based on the CFIR analysis are (1) to appoint a dedicated senior healthcare staff member who combines responsibility, accountability and authority to proactively oversee testing and ongoing referral processes; (2) to reintroduce an education programme for prison healthcare teams to teach about HCV, cirrhosis and how to deliver \u2018opt-out\u2019 conversations and respond to typical responses and (3) to adopt more widely the strategy already shown to be successful in increasing test uptake by the Hepatitis C Trust HITT programme and offer simple incentives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-092965","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T17:26:45Z","timestamp":1761758805000},"page":"e092965","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["An implementation science approach to determine the barriers and facilitators to hepatitis C virus testing in English remand prisons: a mixed-methods study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8596-4073","authenticated-orcid":false,"given":"Kathryn","family":"Jack","sequence":"first","affiliation":[{"name":"Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK"},{"name":"School of Health Sciences, Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-3168","authenticated-orcid":false,"given":"William","family":"Irving","sequence":"additional","affiliation":[{"name":"School of Life Sciences, University of Nottingham, Nottingham, UK"},{"name":"Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe","family":"Rose","sequence":"additional","affiliation":[{"name":"Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian James","family":"Thomson","sequence":"additional","affiliation":[{"name":"Acute Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2025120415085783000_15.10.e092965.1","unstructured":"World Health Organization . 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Nurse Res 2021."},{"key":"2025120415085783000_15.10.e092965.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1748-5908-1-1","article-title":"Welcome to Implementation Science","volume":"1","author":"Eccles","year":"2006","journal-title":"Implementation Sci"},{"key":"2025120415085783000_15.10.e092965.12","doi-asserted-by":"crossref","DOI":"10.1016\/j.psychres.2019.06.036","article-title":"Clarity out of chaos: Use of theory in implementation research","volume":"283","author":"Damschroder","year":"2020","journal-title":"Psychiatry Res"},{"key":"2025120415085783000_15.10.e092965.13","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"2025120415085783000_15.10.e092965.14","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"2025120415085783000_15.10.e092965.15","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"2025120415085783000_15.10.e092965.16","unstructured":"Stewart D . 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