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The National Prison Health Network released a Consensus Statement on the Management of Hepatitis C in Australia’s Prisons in May this year.
The statement aims to guide hepatitis C testing, treatment, and care, in Australian centres with targets (KPIs) to help drive progress towards recommendations.
Why is this important?
Australia sees higher rates of hep C infections amongst the prison population, making it a priority area for testing and treatment on the road to hep C elimination. The prison environment is challenging as people in prison have little to no access to effective, evidence-based harm reduction strategies. Additionally, people within the prison population are often marginalised and experience difficulties engaging with traditional healthcare, including fear of and experiences of stigma and discrimination.
Whereas incarceration offers a unique opportunity to engage people in hep C care and health education. Although it comes with challenges, including infrastructure, staff capacity, frequent movement of people, and competing centre and health priorities.
Most importantly, people in prison have a right to access healthcare to an equivalent standard to that available in the community. What does this mean for hep C care?
- Access to timely testing and treatment
- Access to evidence-based harm reduction (clean tattooing or injecting equipment, cleaning solutions, condoms)
- Timely access to Opioid Substitution Therapy (OST/OAT)
What are the key recommendations?
The statement contains a range of strong recommendations.
A short summary is mentioned below:
- Universal opt-out testing for hep C. Upon arrival, people will be informed of and screened for hep C, ideally within 2 weeks of arrival, unless they decline to be tested. People in prison must be informed of their choice to opt-out of testing.
- Reflex testing to be used for venepuncture collections. Pathology is directed to run an HCV RNA test for anyone positive for hep C antibodies, to check for an active hep C infection. Reducing unnecessary blood taking, and time and movement for both the person and staff.
- Annual re-testing for prison population, in addition to testing upon disclosure of risk factors and as requested.
- People in prison receive culturally appropriate and tailored viral hepatitis education programs. Education extends to clinical and custodial staff, including management, ideally supported with twice-yearly education to ensure up-to-date understanding of viral hepatitis.
- FibroScans are recommended to assess people over 35 years for cirrhosis prior to treatment. If co-factors such as alcohol excess or hep B exist, under 35 years to be assessed where possible.
- Utilise rapid testing pathways, such as Point-of-Care testing, to streamline care from testing to treatment for both people in prison and staff.
- Ensure hep C experienced primary care providers (hepatitis nurses, nurse practitioners, general practitioners) are the preferred providers of in-prison hep C care with appropriate tertiary care support.
- Opportunistic testing anytime beyond 4 weeks post-treatment (SVR4) is sufficient when a 12-week post-treatment test (SVR12) is not practical or possible to check for cure of hep C.
- Upon release, people on treatment should be provided their full course of treatment (under PBS regulation 49) and linked to community-based primary health care.
The statement also acknowledges the successful lead of ACCHO-led primary health care models integrated into Prison Health Services by ACT and South Australia. Providing Aboriginal and Torres Strait Islander peoples access to Aboriginal and Torres Strait Islander practitioners and health workers during incarceration.