Post-release and re-entry into the community

Post-release and re-entry into the community present critical phases for healthcare providers working on viral hepatitis in EU prisons. Ensuring a seamless transition and continuity of care during this period is paramount.

Collaboration with community healthcare agencies to facilitate access to ongoing treatment, follow-up testing, and support services for individuals leaving the prison environment is critical. Establishing strong communication channels, protocols for continuity of care and shared care plans between prison and community healthcare entities is essential to bridge potential gaps in medical information and prevent disruptions in treatment. There may be legal barriers in the transition prison/community regarding access to viral hepatitis services for non-resident individuals.

For continuity of care, antiviral treatment possession, where individuals are provided with instructions around the treatment by a healthcare professional and given the remainder of their medication upon release, has been implemented in some countries including France. This has the potential to bridge the gap related to insurance issues in countries where these issues exist.

In a prison in Montpellier, France, approximately 15% of patients who start the treatment in prison are released before treatment completion. They benefit from continuity of care through the prison active referral programme. View an example of a model of care related to continuity of care from Montpellier.

Active engagement with community organisations, including NGOs, civil society organisations and support groups, can contribute to a more comprehensive and person-centred approach.

Encouraging individuals to participate in community-based programs, such as harm reduction initiatives and counselling services, fosters a holistic continuum of care. By embracing a collaborative and community-engaged strategy, healthcare providers can enhance the effectiveness of post-release viral hepatitis care, promoting the long-term health and well-being of individuals transitioning from the prison to the community setting.

Challenges and solutions: post-release

Challenge	Solution
Information Exchange Barriers: Communicating relevant medical information between prison and community healthcare providers is challenging due to privacy regulations, technology limitations, and variations in record-keeping systems. Ensuring a secure and efficient exchange of health data is crucial for maintaining continuity.	Implementing secure electronic health record systems with interoperability capabilities and standardised protocols for information sharing among healthcare providers (ensuring confidentiality for the individual) and correctional facilities can facilitate seamless exchange of medical information for improved continuity of care in and out of prison settings. See Section 4: Monitoring and Evaluation.
Substance Use: Individuals with a history of substance use, common in prison populations, may face challenges accessing drug use treatment and harm reduction services in the community.  This can complicate the management of co-occurring conditions, including viral hepatitis.  The risk of overdose, including overdose death and relapse in drug use is high after release from prison, especially if no OAT treatment was provided inside the prison, and there was no linkage to external drug treatment upon release.	Developing integrated drug use disorder treatment programs within prison healthcare services, including counselling, opioid agonist therapy and peer support groups, can address drug use issues among inmates and reduce the risk of viral hepatitis transmission associated with injection drug use in the prison.  Improving continuity of care by defining (practical) protocols for linkage to care from community to prison and from prison to community is also important.
Inadequate Follow-Up Planning: Insufficient planning for post-release follow-up care, including the lack of established care plans and coordination mechanisms, can hinder healthcare providers’ ability to ensure continuity of care for individuals undergoing testing or treatment in the prison setting.	Consider the provision of the remainder of HCV treatment upon release. This can support continuity of care and may bridge any gaps related to insurance. It also supports timebound health priorities for those who need to be linked into health services including OAT.