In the West Moreton region of Queensland, Australia, a groundbreaking health initiative is transforming the approach to hepatitis C virus (HCV) testing and treatment within the prison system.

Led by Nurse Practitioner Chris Wallis and Clinical Nurse Linda Hidalgo, this new program aims to test prisoners for HCV as they enter correctional facilities, significantly reducing the time from diagnosis to treatment and ultimately curbing the spread of the virus within and beyond prison walls.

Chris Wallis highlights the program’s pioneering status in Australia: “We believe this project is the first of its kind in Australia to routinely test people for hepatitis C at reception.”

The initiative has received education and support from Hepatitis Queensland, helping to ease initial staff apprehension about the new procedures. “People are more scared of the unknown,” Linda notes, “but now that things have been running for a few weeks, everyone is coming on board and understanding the process.”

Traditionally, screening people in prison for bloodborne viruses was a lengthy process. Prisoners had to wait to be called up to Medical for a blood test, followed by a wait for the pathology results. It could take four to six weeks to confirm a positive HCV diagnosis, during which time the virus could spread within the prison population.

“Now, with the point-of-care testing (POCT) and the rapid HCV antibody tests, we’ve cut that time dramatically,” Linda Hidalgo explains. “When Chris is on-site, we can screen and script someone on the same day.” Qualified as a Nurse Practitioner, Chris can prescribe hepatitis C treatment for those in prison.

This streamlined approach, first implemented at Arthur Gorrie Correctional Centre in March this year, has significantly improved the speed and efficiency of HCV testing. Proactive testing from the first day in the centre ensures a higher rate of follow-up and treatment, which is crucial when the average prison stay might only be two to three months.

Choosing Arthur Gorrie, a sizeable male prison, as the starting point was strategic. “We could have started with a smaller reception centre, like Brisbane Women’s Correctional Centre, but we decided to launch in the centre with the biggest impact,” Linda says.

The success here is a model for expansion, with plans to roll out the program to other centres, including Brisbane Women’s and Brisbane Correctional Centres, in the coming months.

The initiative is not without its challenges. Chris Wallis points to in-house issues such as staff training, infrastructure, and resource management as significant hurdles. “The actual testing of prisoners is the easy part,” he says. Ensuring that all necessary equipment and sufficient space are available adds layers of complexity.

Linda highlights the need for concise and accessible documentation, mentioning the positive feedback from the simplified two-page blood-borne virus pathway and a flow chart designed in collaboration with the Public Health unit.

Another obstacle has been training staff on the RNA point-of-care test. “Arthur Gorrie is a big centre, and we’re limited in the number of people that can be trained on the machine,” Linda notes. Despite this, they have managed to train several staff members and are working towards adding more to handle the workload. Hepatitis Queensland is also providing point-of-care staffing assistance while the project builds capacity.

The reaction from prisoners has been overwhelmingly positive. “They prefer the quicker result and the finger stick collection over traditional phlebotomy,” Linda reports. This quick and less invasive testing method, combined with the prompt start of treatment, makes the entire process more efficient and prisoner-friendly.

From a broader perspective, the program has significant public health implications. “Reducing transmission risk is a huge benefit,” Chris emphasises. By ensuring prisoners are treated for HCV before release, the risk of spreading the virus in the community decreases. The educational aspect of the program also helps prisoners understand the importance of managing their health, both inside and outside the prison.

The introduction of simple HCV antibody tests has streamlined the logistics of testing for all blood-borne viruses. Previously, multiple blood samples were needed, complicating the process and increasing costs. “If an HCV antibody test comes back negative, we then just test for HIV, syphilis and hepatitis B; that’s one tube of blood, and we’re done,” Linda says.

Looking ahead, both Chris and Linda are hopeful about the program’s future. The recent addition of Clinical Nurse Jacqui Cuevas to the BBV Program team will increase the team’s capacity to implement POCT across other West Moreton correctional facilities.

They envision it as a model for other centres across Australia, potentially influencing national health policies and resource allocation. The ultimate goal is a seamless, efficient system that not only addresses HCV but also integrates broader health screenings, improving overall prison health management.

This innovative approach to HCV testing and treatment in West Moreton’s prisons is a testament to the impact of forward-thinking healthcare initiatives in addressing public health challenges. By catching infections early and starting treatment promptly, the program not only improves individual health outcomes but also enhances community health and moves Australia closer to its hepatitis C elimination goals.