Lived experience workers in prisons increase health engagement & care

Abstract Issue People in prisons experience poor physical and mental health and high levels of exclusion. Evidence suggests barriers to healthcare cut across poverty, access, and trust in health workers. In prisons, this is compounded by challenges recruiting and retaining healthcare staff. Evidence shows lived experience workers can overcome these barriers. In England, community health workers with experience of being in prison - known as Peers - work with national prison services to improve HCV care. Intervention Peers work in integrated teams alongside nurses and wider healthcare. Their role seeks to improve knowledge, testing and treatment. Peers have security clearance, enabling them to move around independently and work discretely with individuals. They build trust and use this to enable prisoners to access the healthcare they need. An important part of their work is to increase opt-out testing at prison reception - mandated in England - including through a national mass screening programme. 22 paid peers are employed to work in English prisons; each peer covers 3-4 prisons. They are supported by 200 HCV volunteers. We present an analysis of seven years’ of routinely collected programme activity and data from a mixed methods programme evaluation. Results Peer teams have engaged 171,204 prisoners in the men's and 9,170 in the women's estate since 2018. 7,473 staff have been trained. 54,080 people were tested through 82 mass testing events; an average 91% uptake. Testing on arrival increases following each intervention. Qualitative work highlights the value of peers’ shared lived experience, trust, and the importance of strong collaborative governance. Peers describe multiple positive impacts from their roles. Key messages • Lived expereince teams can improve engagement, outcomes and equity for prison health. • The intervention also increases capacity, benefitting prison healthcare staff, and provides professional opportunities and skills development for peersand development opportunities.