Hepatitis Service Provision at HMP Birmingham: Progressing a Previous Service Improvement Plan

Abstract

IntroductionHepatitis B is a vaccine-preventable disease, and hepatitis C is amenable to treatment. Both are highly prevalent in the prison population. This project provides a comprehensive evaluation of current hepatitis services at Her Majesty’s Prison Birmingham, assessing progress since previous work and proposing further suggestions for improvement.MethodsA review of hepatitis services was undertaken in 2013, in the context of underperformance against national targets. This revealed that the hepatitis B vaccination and hepatitis C testing coverage was 22% and 0%, respectively. A resulting service improvement plan included interventions such as the development of a bloodborne virus (BBV) policy, implementing opt-out testing and introducing dried blood spot testing for ease of administration. In 2015, national guidelines were used to evaluate current practice, with comparison to previous practice. The indicators assessed included BBV policy, vaccination and testing protocols, prisoner education and reporting of results. Discussions were held with prison stakeholders to address areas that required development, producing a revised action plan.ResultsHepatitis services were available to all prisoners starting their sentence in 2015, n=4998. Testing was offered on an opt-out basis to all entrants, increasing the testing coverage by 7.6% from 2013. Vaccination was offered to 57% of entrants, with coverage slightly lower than 2013, largely due to prisoner refusal. In light of this, many strategies were devised to educate prisoners, increase opportunities to receive testing and vaccination, and decrease the risk of patients being lost to follow-up. An update in 2016 saw progress in many of these areas.DiscussionBeing in prison provides offenders with stability in their lifestyle and easier access to healthcare services. By optimising these services in line with national guidance, and implementing specific strategies to encourage uptake of hepatitis testing and vaccination, we may be better able to serve this vulnerable sector of the population.

Interventions to improve the implementation of evidence-based healthcare in prisons: a scoping review

“…Eight studies took place in US detention centres (Beyda et al, 2018;Emerson et al, 2020;Lee et al, 2016;Lin et al, 2019;Meine, 2018;Pankow et al, 2018;Pearson et al, 2014;Reeves, 2012;Toledanes et al, 2021), four in the UK (Arif, 2018;Finnie, 2018;Francis-Graham et al, 2020;Morey et al, 2019), and one each in France (Cabelguenne et al, 2018;Lerat et al, 2011), Ireland (O'Toole et al, 2018 and Canada (Elwood Martin et al, 2004).…”

“…Twelve studies involved adult custodial settings; those holding males exclusively in seven studies (Arif, 2018;Cabelguenne et al, 2018;Finnie, 2018;Francis-Graham et al, 2020;Lerat et al, 2011;Lin et al, 2019;Morey et al, 2019;O'Toole et al, 2018) and holding females exclusively in three (Elwood Martin et al, 2004;Emerson et al, 2020;Meine, 2018). Two studies did not specify gender of the incarcerated persons (Pankow et al, 2018;Pearson et al, 2014;Reeves, 2012).…”

“…Of the eight US studies, three occurred in jails (Emerson et al, 2020;Lin et al, 2019;Meine, 2018), three in juvenile detention facilities (Beyda et al, 2018;Lee et al, 2016;Toledanes et al, 2021), one in prison (Reeves, 2012), and one in paired prisons or jails (Pankow et al, 2018;Pearson et al, 2014). Of the four UK studies, one studied a Category A (high security) prison (Francis-Graham et al, 2020), two studied Category B (remand and long-term) prisons (Arif, 2018;Morey et al, 2019) and once studied a Category C (training and resettlement) prison (Finnie, 2018).…”

Hepatitis C Virus Prevalence, Screening, and Treatment Among People Who Are Incarcerated in Canada: Leaving No One Behind in the Direct‐Acting Antiviral Era

“…9 HCV screening at intake to federal corrections is universally offered to all entrants, with 80% to 90% accepting testing. 6 Universal, or opt-out, testing in correctional settings results in higher uptake compared with opt-in or ondemand testing, [10][11][12] and therefore should be a high-priority intervention for all correctional settings. All PWAI in federal institutions are eligible for HCV treatment irrespective of fibrosis staging and are offered treatment by CSC-contracted physicians.…”

“…Because screening is the first step in HCV care, increasing uptake is crucial to improving care pathways for PWAI and may positively impact transition into the community 33 ; therefore, universal STBBI screening at intake should be implemented, as has been done by CSC and in Alberta. Point‐of‐care 34,35 or dried blood spot 11 testing could facilitate universal HCV testing strategies among PWAI. To increase overall HCV care of PWAI, responsibility for the provision of health care in correctional centers should be transferred to local health authorities, as has now been done in several Canadian provinces.…”