Development of a model for HIV, syphilis, and hepatitis C screening services for prisoners in Health Region 8, Thailand, 2020–2021

Abstract

This action research aimed to develop a model for HIV, syphilis, and hepatitis C virus (HCV) screening services for prisoners. The study targeted two groups: (1) 35 healthcare staff from provincial health offices, hospitals, and prisons; and (2) 7,876 prisoners with risky behaviors from five prisons in Health Region 8. The study was conducted from October 2019 to September 2021. Data were collected using behavior assessment questionnaires, screening record forms, focus group discussions, and after-action reviews. Quantitative data were presented using frequencies and percentages, while qualitative data were analyzed through content analysis. The results revealed two screening models: (1) a participatory screening model involving network partners operating under normal conditions; and (2) a prison-led model operating under emergency conditions during the COVID-19 pandemic. The new differences include flexible management tailored to the situation, the delegation of authority to prisons to manage core operational processes, and systematic coordination of laboratory testing through network partners, all contributing to enhanced continuity of the service delivery system. Screenings increased from 1,209 to 6,667 for HIV, from 1,209 to 2,648 for syphilis, and from 1,209 to 5,604 for HCV between 2020 and 2021. The prevalence rates of HIV, syphilis, and HCV during 2020–2021 were 0.99% and 0.66%, 2.56% and 1.78%, and 0.90% and 1.39%, respectively. Key success factors included leadership support for policies, participation from network partners and effective management. It is recommended that services be provided continuously and extended to cover newly admitted prisoners in order to prevent disease transmission to other inmates, while also emphasizing health education, counseling, and the provision of self-protection tools for existing prisoners with risky behaviors.