People in custody in Canadian provincial prisons experience disproportionately high rates
of hepatitis C virus infection. Despite national and international calls for hepatitis C elimination,
treatment access remains inconsistent within correctional settings. This integrative review
examines the barriers primary care providers face in delivering hepatitis C care to people in
custody in Canada. Following Whittemore and Knafl’s (2005) five-step framework, nine peerreviewed studies published between 2015 and 2024 were analyzed using thematic synthesis.
Studies included qualitative, quantitative, and mixed method designs, and were drawn from
Canada, Australia Austria, the United States, and international contexts. Five global themes
emerged: (1) inconsistencies in screening, treatment access, and healthcare systems across
institutions; (2) variable access to opioid agonist therapy and harm-reduction services; (3)
challenges in implementing opt-out hepatitis C screening; (4) poor linkage to care post-release;
and (5) education gaps among both providers and people in custody. Barriers were found to be
compounded by the coercive nature of correctional environments, institutional fragmentation,
and limited continuity of care. The review supports recommendations for transferring healthcare
oversight to public health authorities, expanding nurse practitioner-led care, implementing harm
reduction practices, and strengthening intersectoral collaboration to improve system level
coordination. Addressing these systemic issues is essential to meeting hepatitis C elimination
targets and improving health equity for incarcerated populations.
